Breast CancerTherapeutics management

Dr. Jubran K. HassanPh.D of clinical pharmacy

Treatment Goals & Options for Breast Cancer• Include the following:1- Induction of cure 2- Prevent metastasis3- Palliation of symptoms• Treatment options for diagnosed breast cancer

Treatment for Breast Cancer• Surgical treatment Surgery is definitive treatment in early-stage disease. And include:1- Lump removal (75% of cases)2- Radical breast removal (radical mastectomy) (25% of cases)

Treatment for Breast Cancer• Radiation (radiotherapy)• may be offered in addition to surgery when1- the tumor size >5cm2- if there are >4 positive lymph nodes, 3- if positive tissue margins are present.Benefit of radiotherapy:1-try to cure caner by killing cancerous cell2- ameliorate symptoms for non curable tumor3- used prior to surgery to shrink large size tumor (NHS choices 2016)

Treatment for Breast Cancer• Radiation (radiotherapy) • When is Started ?• in about a month after your surgery or chemotherapy ?• What will be the course of treatment?• 3- 5 days / week for 3- 6 weeks . Each session will only last a few minutes.• What the types of radiation method are used?• Depending on cancer type and type of surgery

Treatment for Breast Cancer• Radiation (radiotherapy) • Types include:• Breast radiotherapy –radiation is applied to the whole of the remaining breast tissue ;after

breast-conserving surgery, • chest wall radiotherapy – after a mastectomy, radiotherapy is applied to the chest wall• breast boost – some women may be offered a boost of high-dose radiotherapy in the area

where the cancer was removed; however, the boost may affect the appearance of the breast, and may leads to fibrosis

• radiotherapy to the lymph nodes – where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes

• Partial breast radiation results in two significant advantages over whole breast radiation: it spares healthy tissue from unnecessary radiation and reduces treatment time from several weeks to just 5 days. Initial research indicates APBI can be as effective as whole breast radiation in terms of survival and controlling local recurrences.5

Treatment for Breast Cancer• Radiation (radiotherapy) • Side effects:• irritation and darkening of the skin on your breast, which may lead to sore,

red, weepy skin• extreme tiredness (fatigue)• excess fluid build-up in your arm caused by blockage of the lymph nodes

under your arm (lymphoedema)

Treatment for Breast Cancer• Pharmacotherapy (adjuvant therapy)• Include:• Chemotherapy (by cytotoxic agents)• Hormonal therapy• Biological agents• Systemic adjuvant chemotherapy, hormonal therapy, or biologic therapy

is used to manage microscopic disease and diminish the chance of recurrence post-surgery or radiation

Treatment for Breast Cancer• Pharmacotherapy • Chemotherapy (cytotoxic agents)• Purpose: to kill the cancer cells.• When it could be used :

1- It's usually used after surgery to destroy any cancer cells that haven't been removed. This is called adjuvant chemotherapy.

2- In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumor. This is called neo-adjuvant chemotherapy.• How many medications given in course of treatment? • Several different medications are used for chemotherapy, and three are often given at once.• How medications are chosen?

• The choice of medications and the combination will depend on the type of breast cancer you have and how much it's spread.

Treatment for Breast Cancer• Pharmacotherapy • Chemotherapy (cytotoxic agents)• How medications are given?• The medications are usually given through a drip straight into the blood

through a vein. • In some cases, you may be given tablets that you can take at home. • How long and how many time the medication are given in session?• You may have chemotherapy sessions once every two to three weeks, over

a period of four to eight months, to give your body a rest in between treatments.

Treatment for Breast Cancer• Pharmacotherapy • Chemotherapy (cytotoxic agents)• What are the adverse effects of cytotoxic agents?• infections• loss of appetite• nausea and vomiting (may be severe)• tiredness• hair loss • sore mouth

Treatment for Breast Cancer• Pharmacotherapy • Chemotherapy (cytotoxic agents) combinations

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy• Why it should be used :

• Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body.

• These types of cancer are known as hormone receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects.

• How the hormonal therapy is selected?

• The type of hormone therapy you'll have will depend on the stage and grade of your cancer, which hormone it's sensitive to, your age, whether you've experienced the menopause, and what other type of treatment you're having.

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy

• When it should be used?

• You'll probably have hormone therapy after surgery and chemotherapy, but it's sometimes given before surgery to shrink a tumor, making it easier to remove.

• Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you having surgery, chemotherapy or radiotherapy.

• How long it could be used?

• In most cases, you'll need to take hormone therapy for up to five years after having surgery. If your breast cancer isn't sensitive to hormones, hormone therapy will have no effect.

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy

• What they are?1- Tamoxifen• Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. It's taken every day

as a tablet or liquid.• It can cause several side effects, including:• tiredness• changes to your periods• nausea and vomiting• hot flushes• aching joints• headaches • weight gain

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy• Aromatase inhibitors• Preferred for menopause, • block enzyme responsible to convert androstendione and testasterone into estrogen hormone.• These are anastrozole, exemestane and letrozole. These are taken as a tablet once a day.• Side effects include:• hot flushes and sweats• lack of interest in sex (loss of libido)• nausea and vomiting• tiredness• aching joints and bone pain• headaches• skin rashes

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy• Ovarian ablation or suppression• Used for non menopause, Ovarian ablation or suppression stops the ovaries working and

producing oestrogen.• Could be done by using surgery or radiotherapy. • Or by medications called goserelin, which is a luteinising hormone-releasing hormone agonist

(LHRHa).• Goserelin is taken as an injection once a month and • It can cause menopausal side effects, including:• hot flushes and sweats• mood swings• trouble sleeping

Treatment for Breast Cancer• Pharmacotherapy • Hormonal therapy

Treatment for Breast Cancer• Breast cancer Survival rate (5 years survival)

100% 100% 93% 72% 22%

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