The new treatments used in the management of metastatic breast cancer have brought very significant progress in terms of the life expectancy of patients but also in the quality of their life during treatment.
- Metastatic breast cancer affects approximately 20% of women with localized breast cancer
- New treatments acting in a targeted way according to tumor mutations have demonstrated their effectiveness
- Thanks to these treatments, survival in this disease is on average 4 years but sometimes much more.
Life expectancy in metastatic breast cancer has doubled and now exceeds four years – but sometimes much more – in living conditions very close to normal. Progress mainly due to the new treatments used, in particular anti-CDK 4/6 which are oral treatments, in the management of this disease which can be diagnosed immediately (about 4% of cases) or appear after a remission or cure in localized breast cancer. It is estimated that 20% of women with localized breast cancer treated are at risk of developing metastatic breast cancer later.
This metastatic cancer most often affects the bones, lungs or liver and is caused by migration to these organs, through the blood system and the lymphatic system, from the initial tumour. It should be treated not as cancer of the organ in which metastases have developed but as metastatic breast cancer as such.
Precision medicine
The treatment of these cancers has been profoundly modified thanks to advances in so-called precision medicine, which allows a very detailed analysis of the mutation capacities of the tumor and its metastases. It is on the mechanisms that generate these mutations that targeted therapies act.
While high-throughput sequencing will eventually make it possible to search for all existing mutations in order to identify very precisely those involved in each particular case, kits already make it possible to search for mutations located on certain genes, research that can be carried out on a biopsy of the primary tumour, on a metastasis or on the tumor DNA circulating in the blood, which is called a liquid biopsy.
The role of anti-PARPs
This research focuses in particular on anomalies of the BRCA, one of the genes implicated in the development of breast cancer that normally maintains genomic integrity to prevent the uncontrolled proliferation of breast cells. In the case of a mutation of this gene, anti-PARPs are very effective in the management of patients. These PARP inhibitors are likely to become of considerable importance in the treatment of cancers linked to BRCA mutations.
The work of oncologists today consists of discovering the best combinations between the different molecules. “For this type of cancer, new oral targeted treatments have recently become available which can significantly improve the prognosis of patients when combined with hormone therapy,” explains Dr. Mahasti Saghatchian, breast cancer oncologist at the hospital. American from Neuilly.
Metastatic breast cancer can also be treated, depending on the situation, with chemotherapy or targeted drugs that block specific cancer cell mechanisms. And for some tumors, surgery or radiotherapy may also be necessary in combination with treatments with medication stockings. Surgery is most often used for local treatment of metastases, ie by intervening on the organ or organs in which the initial tumor has spread.
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