Lori Jensen, MD, on what’s new in breast cancer treatment

About 1 in 8 U.S. women will develop breast cancer over the course of a lifetime. But there is reason for hope. There is an abundance of new treatments available, some having just been approved at end of 2021!

Lori Jensen, MD, of Rocky Mountain Cancer Centers, presented a free health lecture on “What’s New in Breast Cancer Treatment.” She opened her lecture noting, “This is an exciting time to be a medical and, especially, a breast cancer oncologist. There’s been enormous growth in the availability of effective, life-saving treatments for breast cancer, with an overwhelming choice in treatments now available.”

Dr. Jensen added, “While there is still a role for chemotherapy in treating breast cancer, the direction we are seeing treatments move toward is in the development of new targeted agents, as well as toward immunotherapy.”

Video: Watch "What's new in breast cancer treatment"

RISK FACTORS

Dr. Jensen emphasized, “The two biggest risk factors that make a person susceptible to breast cancer are being a female and being over 50. She stated:

• 70-80% who are diagnosed with breast cancer don’t have a family history
• 5-15% do have a family history—however, there isn’t an identifiable mutation that explains why there’s cancer in the family
• 10-15% have been diagnosed as having truly hereditary breast cancer with an associated known genetic mutation

“While there are many genetic mutations associated with breast cancer,” said Dr. Jensen, “the two most common are BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2).” Everyone has two copies of each: one copy inherited from each parent. Those who inherit harmful variants of one of these genes have increased risks of several cancers, most notably breast and ovarian cancer.

STAGING SYSTEM

Breast cancer stages are labeled stage 0 through stage 4. This is a way to help define the extent of the cancer. “With stage 1 through 3, we’re working to reduce the risk of the cancer returning. With stage 4, treatments are not able to cure the disease. The goal is to prolong the patient’s life and to relieve symptoms.” She added, “With new treatments, women with stage 4 breast cancer are now living years longer than they did even five years ago.”

• Stage 0—the cancer is limited to the inside of the milk duct and is non-invasive
• Stage 1—tumors are less than 2 cm with negative lymph nodes
• Stage 2 or 3—these are larger tumors in the breast or involve nearby lymph nodes
• Stage 4—the cancer has spread outside the breast and lymph nodes (bone, lung, liver, brain)

Dr. Jensen described the new staging system as one that considers the biology of the tumor, not simply the size of the tumor and the involvement of the lymph nodes. “We want to understand how aggressive the cancer cells are, not just the size or whether the lymph nodes are involved,” said Dr. Jensen.

Staging also helps determine treatment goals. “For stages 1 through stage 3,” said Dr. Jensen, “we remove the cancer with surgery or radiation. However, we recognize it’s possible that microscopic cells may have escaped and gotten into the blood stream.” She added, “The treatments we are discussing here are geared at treating these microscopic cells.”

TESTING FOR RECEPTERS

Dr. Jensen explained, “Every breast cancer is tested for receptors. Receptors are proteins in or on cells that detect hormone signals telling the cells to grow. There is an estrogen and progesterone receptor. Each can be positive or negative." Keeping estrogen and progesterone hormones from attaching to the receptors can help keep the cancer from growing and spreading.

The results of hormone receptor testing help determine whether the cancer is likely to respond to hormonal therapy or other treatments. If the cancer is hormone-receptor-negative (no receptors are present), then hormonal therapy is unlikely to work and other treatments will be explored.

HER2 is a protein that helps breast cancer cells grow quickly.
Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein. “About 15-20 percent of breast cancers are Her2 positive,” stated Dr. Jensen.

She added, “There are several combinations or subsets of these receptors that can occur. When all the receptors are negative—estrogen, progesterone and HER2 protein—it’s called a triple negative breast cancer.” Triple negative breast cancer is rare, affecting about 13 in 100,000 women each year.  It’s one of the more challenging breast cancers to treat. But researchers are making steady progress toward more effective treatments.

New Breast Cancer Index Test

The Breast Cancer Index™ (BCI) is a new tool. This test helps predict the risk of early-stage, hormone-receptor-positive breast cancer coming back. It helps doctors decide whether extending hormonal therapy five more years (for a total of 10 years) will be beneficial. The breast cancer index reports how likely the cancer is to return five to 10 years after diagnosis and if a woman is likely to benefit from extending the therapy.

LATEST THERAPIES AND TREATMENTS

Adjuvant vs. Neoadjuvant Therapy

Adjuvant therapy is given to Stages 1 through 3 cancer patients after surgery to treat microscopic cells that may have escaped from the breast. “This can improve the cure rate and reduce the chance of the cancer returning,” said Dr. Jensen. Adjuvant therapy may include chemotherapy, radiation therapy and/or targeted therapy.

Neoadjuvant therapy is typically a chemotherapy or hormone therapy treatment given prior to surgery. Dr. Jensen explained, “It helps us understand how sensitive or resistant the cancer is to the neoadjuvant therapy, giving us an idea of how much cancer will remain after the treatment. If the tumor responds to this treatment before surgery, we know the patient is more likely to do well.”

She added,“Neoadjuvant therapy is being used more in the last year for triple negative, Her2 positive cancers and lymph node treatment. Used at the time of diagnosis, we potentially remove fewer lymph nodes and reduce the chance of swelling of the arm.”

Antiestrogen Therapy

Antiestrogen therapy is a hormonal therapy focused on slowing or stopping the growth of hormone-sensitive tumors. The therapy can block the body's ability to produce cancer-causing hormones or it can change the way hormones affect breast cancer cells.

Targeted Treatments

Targeted therapy uses the body's immune system or hormonal system to fight breast cancer cells. There are two categories of targeted oncology therapies:

• Small molecules - These oral targeted agents enter the cancer cell and inhibit the function of proteins that are important for cell growth. “They switch off the pathway,” said Dr. Jensen.
• Monoclonal antibodies - Monoclonal antibodies mimic the immune system’s natural ability to fight off infection and are changing the way doctors treat cancer. They are given intravenously and work to inhibit the growth of cancer cells.

CDK Inhibitors

CDK inhibitors are important new drugs used in targeted therapy to improve antiestrogen therapy outcomes. Dr. Jensen said, “CDK inhibitors have been enormously beneficial in estrogen-receptor-positive cancers.” When added to antiestrogen therapy, they prolong remission by up to a year for stage 4 cancer.

Monoclonal Antibodies Used in the Treatment of Her2 Positive

Protein antibodies, such as Herceptin and Perjeta, can now be given as injections rather than intravenously. These targeted therapies work against Her2 positive breast cancers by blocking the cancer cells’ ability to receive growth signals.

Oral Agents for Her2 Positive Disease

There is a group of new oral pills that affect the Her2 pathway. “These pills may allow us to get away from giving these treatments intravenously or through injections,” said Dr. Jensen.

PARP Inhibitors—Oral Targeted Pills

PARP inhibitors have emerged as important new therapies for breast cancer patients who have an inherited BRCA mutation. Currently there are two PARP inhibitors approved for breast cancer: Olaparib and Talazoparib.

Immunotherapy

Administered intravenously, immunotherapy uses the body’s own immune system to fight the cancer. The biggest benefit is seen in triple negative cancers. “What is really exciting,” said Dr. Jensen, “is that in July 2021, the FDA approved the use of immunotherapy in conjunction with chemotherapy for stage 2 and stage 3 cancers. Studies have shown that there was an improvement in reducing the chance of the cancer reoccurring.”

Chemotherapy

Chemotherapy can be used to increase the chance of a cure, decrease the risk of the cancer returning, alleviate symptoms from the cancer or help people with cancer live longer with a better quality of life. Those who will benefit from chemotherapy include:

• Most Her2 positive patients—these are faster growing cancers and are treated with chemotherapy combined with a targeted treatment called Herceptin (a very effective antibody)
• Most estrogen-receptor-positive, progesterone-receptor-negative and Her2 negative cancers
• Some estrogen-receptor-positive and Her2 negative cancers

MAKE AN APPOINTMENT

Please visit the Rocky Mountain Cancer Centers website or call 303-385-2000 for more information and to schedule an appointment with Lori Jensen, MD.

Click here to view/download a PDF of the lecture slides and to view the online lecture click here.

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