Breakthroughs in Breast Cancer: Innovation Creates Optimism

As researchers continue to discover new ways to test and treat breast cancer, the number of cases and poor outcomes should begin to decline.

Breast cancer is one of the two most common cancers worldwide, affecting 1 in 8 women in the United States. However, if caught early, the 5-year survival rate is 99%. Thanks to multiple advances in detection and treatment, patients are leading full lives after diagnosis. From personalized therapies to cutting-edge technology, innovative developments are transforming how we manage breast cancer. Let's look at some recent breakthroughs and scientific achievements the medical community has to offer currently or in the near future. Have researchers discovered a better way to approach this ubiquitous disease?

Personalized Medicine: A unique treatment for every patient

With the rise of personalized medicine, many treatments are now being customized to meet the specific genetic needs of each patient and their tumors. This individualized approach has finally reached breast cancer care. 

Genetic Profiling and Targeted Therapies

Traditionally, chemotherapy was a constant component of breast cancer treatment regimens. However, a July 2018 study published in the New England Journal of Medicine revealed that chemotherapy may provide no benefit for up to 85% of patients over age 50 with HR+, HER- breast cancer that has not spread to any lymph nodes. This study indicated that patients at low to moderate risk could skip chemotherapy, thereby avoiding hair loss, neuropathy, weight loss, and many other side effects. But what about other forms of breast cancer?

Currently, genomic testing is being used to create therapies that directly target cancer cells while minimizing chemotherapy exposure. Advances in genetic testing have enabled oncologists to identify specific mutations that lead to particular types of tumor growth. As a result, drugs have been developed to specifically target these cancer cells while sparing healthy ones, resulting in recovery with less damage and fewer side effects. Some patients may even be able to forego chemotherapy altogether which can significantly increase quality of life during treatment. 

1. HER2-positive breast cancer is breast cancer that tests positive for a protein called human epidermal growth factor receptor 2. HER2 promotes the growth of cancer cells, and this kind of breast cancer tends to be more aggressive than other types, making early detection even more critical.  For example, the drug trastuzumab deruxtecan (Enhertu) has been approved for metastatic breast cancer. In June 2024, results from a clinical trial showed that more patients may benefit from Enhertu. It has been shown to be effective in up to 85% of patients with different forms of HER2 metastatic breast cancer. 

2. An oral option for targeted therapy is currently being designed. PARP inhibitors, such as Olaparib (Lynparza), which were originally approved only for ovarian cancer, are now FDA-approved for the treatment of several different types of breast cancer. PARP (poly ADP-ribose polymerase) is an enzyme found in each of our cells that helps repair DNA damage. PARP inhibitors work by preventing PARP from repairing tumor DNA, ultimately leading to the death of the tumor cells. 

3. Additionally, doctors are getting closer to identifying which patients with early HER2-positive breast cancer can safely forgo chemotherapy using the HER2DX genomic test. This is the first test specifically designed to identify HER2-positive patients at high and low risk of recurrence.

Hormone Receptor-Positive Treatments

Hormone receptor-positive breast cancer consists of cells that have tested positive for either estrogen (ER) or progesterone (PR) receptors or both. When these receptors, also known as proteins, are positive, it indicates that when estrogen or progesterone bind to them, they promote the growth of cancer cells. Understanding whether your cancer is positive for these receptors is crucial for determining the appropriate type of treatment you require. 

A selective estrogen receptor degrader (SERD) drug called elacestrant is now available for this type of breast cancer. Clinical trials have demonstrated significant improvements in progression-free survival for patients with advanced disease. Typically offered after traditional therapies have failed, ongoing studies aim to make it available as a first-line treatment in the future. 

Hereditary cancer identification

The identification of hereditary cancer syndromes is undergoing improvement. In addition to the known genetic mutations (BRCA1 and BRCA2), others are also being discovered. Multiple family members can now be identified by analyzing blood and saliva. Enhanced screening and innovative gene sequencing techniques, which are now even faster thanks to AI, can recognize additional hereditary cancer syndromes that pose risks to individuals. Preventative medicine can now be utilized prior to diagnosis. 

Immunotherapy: A dream realized and game-changing treatments

Immunotherapy boosts the power of the body’s own immune system to find, attack, and kill cancer. Until recently, this was only available for some blood cancers, but due to new, groundbreaking advances in the field, it can now be used for breast cancer. 

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer. It is also more likely to spread before diagnosis and to recur. These cells lack estrogen and progesterone receptors and produce little or no HER2 protein. This means TNBC cannot be treated with any of the aforementioned drugs.  

Checkpoint inhibitors, an immunotherapy treatment, have been approved for treating triple-negative breast cancer. For example, pembrolizumab (Keytruda) blocks the proteins that prevent the immune system from attacking cancer.  It boosts the body's immune system, making the antibodies more effective at finding and killing the cancer cells. It even helps the body “remember” the cancer.  Because of this, these drugs have even helped some patients remain cancer-free after initial remission. 

Although immunotherapy is effective, it can cause significant side effects. While it is well-known for greatly reducing the recurrence of cancer, how much is really needed? Currently, all individuals with early TNBC are treated with chemotherapy followed by immunotherapy before surgery. They continue to receive additional immunotherapy for up to 27 weeks afterward. In a new phase 3 clinical trial, patients are observed after surgery without postoperative immunotherapy. The study aims to identify which patients can safely pursue this treatment plan while maintaining positive outcomes. 

Combination Therapies: 

Initially used for blood cancers, immunotherapy is still evolving and remains ineffective for some solid tumors when used by itself. However, researchers are investigating the combination of chemotherapy and immunotherapy. Often, a low dose of chemotherapy is given before the immunotherapy is started. This aims to shrink tumors and maximize the immune system response. It is still in clinical trials, but the results have been promising. 

Advances in Detection-The rise of technology and early disease recognition to save lives

One of the most crucial factors in breast cancer prognosis and survival rates is early detection. Traditional methods have been lacking at best, with many faulty results. Luckily, new and improved technological advances are boosting accessibility and accuracy. New advancements are available in imaging for mammography and ultrasound, as well as the use of artificial intelligence to aid in mammography analysis.

Liquid Biopsies

Liquid biopsies are a new noninvasive screening tool that detects cancer DNA in the bloodstream. This emerging tool could be used for early detection and to allow real-time monitoring of treatment effectiveness without requiring invasive procedures. 

Innovative detection technology is the game changer we need for the early identification of breast cancer before it spreads.

Tomosynthesis (3D Mammography)

Previously only available at a handful of places, this type of mammography is now a standard option at many clinics. The 3D technology offers better visuals and more detailed images than traditional mammography. This improvement enhances detection rates, particularly for the 1 in 10 women believed to have dense breast tissue, making this aspect extremely important for imaging-based identification.

Cerianna

A diagnostic imaging agent used to detect ER-positive cancer metastases. Until now, a PET scan alone was used to determine whether or not breast cancer spread.  However, if the cancer metastasizes, it can evolve into other forms of breast cancer than the original tumor, meaning the new tumor may not respond to the original form of treatment. When the agent Cerianna is added, doctors can use PET scans to immediately assess whether estrogen receptors are present in metastatic lesions, aiding in the determination of the most effective course of therapy instead of waiting for further results.

Navigating the Human Side of Breast Cancer

Advances in treatment and detection are only part of the story. The emotional and physical toll that cancer takes on patients and their families is profound. New programs are being developed to assist these individuals during their time of need. 

Psychosocial Support Organizations

Targeted for victims of cancer, organizations like American Cancer Society and Breast Cancer Alliance offer support to help alleviate the crushing feelings of isolation and anxiety that many individuals experience after a diagnosis. For some, the comfort these groups offer can be just as crucial as any medication. 

Survivorship Care Plans

Numerous cancer centers are developing individualized plans that empower patients to take an active role in their post-cancer journey. The plans provide ongoing guidance on follow-up care, managing side effects, and maintaining a healthy lifestyle after treatment. This helps patients move forward with confidence and the right information to lead a long life. 

What’s Next??

Rapid advances in research continue with new clinical trials exploring everything from vaccine therapies to artificial intelligence-driven treatment plans, testing, drug development, and even nanotechnology. As of August 2024, several new drugs are undergoing clinical trials but have not yet received FDA approval. A new era of collaboration among researchers, healthcare practitioners, patient advocates, and patients is essential for making this endeavor successful. Fortunately, the future looks promising. The transition of science into real-life medicine is happening faster than ever before.  

For breast cancer patients, a more individualized, holistic approach is being promoted, offering more than just improved outcomes. There is now renewed hope for survivors from diagnosis through treatment to remission and beyond. Some of our brightest minds are confident that someday soon, we will live in a world where a cancer diagnosis will no longer carry a life-altering prognosis. Through the hard work, dedication, and the collaboration of multiple institutions breast cancer may have finally met its match.

If you or a loved one is navigating a breast cancer journey, know that help and hope are within reach. Stay informed, advocate for yourself, and never hesitate to seek the support you need.

References

American Cancer Society. (2024). Advances in breast cancer treatment. Retrieved from https://www.cancer.org

ClinicalTrials.gov. (2024). Ongoing breast cancer trials. Retrieved from https://www.clinicaltrials.gov

MD Anderson Cancer Center. (2019). 6 advances in breast cancer diagnosis and treatment. Retrieved from https://www.mdanderson.org

National Cancer Institute. (2024). Immunotherapy and breast cancer. Retrieved from https://www.cancer.gov

Susan G. Komen. (2024). What’s new in breast cancer. Retrieved from https://www.komen.org

The New England Journal of Medicine. (2018). Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. Retrieved from https://www.nejm.org