Breast cancer, the key role of adjuvant therapy immediately after surgery to have a better chance of healing- time.news

by time news
from Vera Martinella

It is decisive to respect the times to operate and then start the most suitable treatment for each woman, which is based on different types of drugs and is chosen on the basis of various parameters. The goal: to reduce the risk of relapses and metastases

One in eight women in Italy will get breast cancer in their lifetime. Thanks to the many advances made both with early diagnosis, through mammography screening, both with new and increasingly targeted and effective therapies, today 87% of patients are alive five years after diagnosis and 89% at ten years, yet breast cancer remains the leading cause of cancer death among Italians. For this reason, it is crucial to establish how best to proceed after surgery and to do it in a timely manner with a specific goal: minimize the chances of the disease returning with a recurrence or progressing to metastasis. Like? With the so-called adjuvant therapy, which is based on several drugs and is chosen based on different parameters.

Italy, 55 thousand new cases diagnosed in 2020

This was discussed in a meeting, part of an awareness project on adjuvant therapy carried out with the unconditional support of Pierre Fabre, which was attended by two of the leading Italian experts in the treatment of this neoplasm. “With almost 55 thousand new cases diagnosed in 2020, breast cancer is the most common not only among females, but in the entire population – underlines Francesco Cognetti, president of the Together Against Cancer Foundation -. And the cases are constantly growing. Adjuvant therapy of radically operated disease can be considered one of the greatest successes in oncology in the last 30 years: in fact, despite the continuous increase in cases, mortality decreased by 6.8% compared to 2015, not only as a result of early diagnosis through screening programs, but also due to the effectiveness of the therapy. And our country is at the top in Europe in terms of survival rates. There are three adjuvant treatments – chemotherapy, hormone therapy and biological therapy – offered to patients based on the study of the individual case, the characteristics of the tumor and the physical conditions of the woman, without neglecting her wishes and needs “.

Symptoms and treatments

The risk of getting sick increases with age until menopause, then stops and increases again after 60. What makes the difference in the hope of recovery is, first of all, early diagnosis. For this it is essential not only to perform the regular checks providedbut also regularly perform breast self-examination (about once a month), looking for suspicious signs such as a lump that does not cause pain and has irregular contours, swelling, nipple changes, or leaking fluid. Thanks to periodic checks with mammography and greater awareness of women, most breast cancers are diagnosed at an early stage, when surgery can be more often conservative (avoiding mastectomy, i.e. the removal of the entire breast ) and the therapy prescribed immediately after is able to be more effective allowing to obtain very high survival rates. “In addition to the lives saved, more healings also translate into a containment of costs for drugs, visits and hospitalizations and, therefore, savings for the health system – highlights Pierfranco Conte, president of the Periplo Foundation -. With the Re.Mi projects, supported by the Periplo Foundation, we have defined the minimum requirements for the diagnostic, therapeutic and assistance pathway (PDTA) of breast carcinomas: for the patient with breast cancer undergoing surgery, the intervention must be performed within 30 days from when the indication is given. AND adjuvant therapy should be started within 8 weeks of the operation. Scientific evidence has shown that delays can compromise the effectiveness of treatments “.

What is adjuvant therapy and what is it for?

“Today we know that there are many different types of breast cancer, some much more aggressive than others – explains Conte -. Adjuvant therapy, after the operation, aims to block the growth and spread of any residual cancerous cells and reduce the risk of relapse or the formation of metastases ». Which type of treatment to prescribe (hormone therapy, with a variable duration depending on the case, poly-chemotherapy, molecular target therapy) is established by evaluating the risk of disease recurrence in the individual patient based on the biological characteristics of the tumor (there are also some subtypes in which the cancer cells remain “dormant” for 15 or 20 years) and evaluating the extent of the foreseeable benefit with respect to any toxicity of the therapy, the patient’s preferences, the presence of any other concomitant diseases and life expectancy, therefore also considering the age of the woman. «Most of the relapses have an inevitable course towards metastatic disease – adds Cognetti -. This is why the enhancement of adjuvant therapies represents the only way to reduce the chances of relapse, with a consequent increase in definitive healings. New possibilities are now available because recent studies have shown that innovative drugs, added to standard therapies for the 15-20% of patients not yet cured, are able to further reduce relapses after 5 years “.

The treatment process for the HER2 positive subtype

From the numbers presented during the meeting, it emerges that the majority of patients, about 46,200 (84% of new cases per year), present early stage disease (stage I, II or III) and 7 thousand (15% of the latter) are characterized by overexpression of the HER2 protein (HER2 + positive). In this population, adjuvant treatment with chemotherapy, hormone therapy and one year of biological therapy with an anti-HER2 antibody today represents the standard of care and is able to reduce the risk of relapse (local, regional, distant) and death. «Patients with operable HER2 positive breast cancer are now being treated with personalized treatments based on the level of risk based on the size of the tumor and the possible involvement of the axillary lymph nodes – explains Conte -. For tumors larger than 2 centimeters and / or with palpable axillary lymph nodes and / or highlighted on axillary ultrasound, standard treatment is pre-operative chemotherapy associated with trastuzumab followed by surgery. Then, if there is no more cancer post-op, one year of trastuzumab is completed; if, on the other hand, breast and / or lymph node cancer persists, patients are treated with TDM1, an anti-HER2 antibody which carries a powerful cytotoxic on cancer cells. Smaller tumors are operated immediately and then treated with postoperative chemotherapy plus trastuzumab if the lymph nodes are negative or chemotherapy plus trastuzumab and pertuzumab if the lymph nodes are positive. Hormone therapy – continues the specialist – is added in all cases in which the tumor also expresses hormone receptors. These therapeutic choices have significantly improved survival, making HER2 positive disease curable in the vast majority of patients, but they did not eliminate the risk of the tumor returning. A percentage of patients between 15 and 20% continue to relapse with a peak incidence 18-24 months after surgery, although some patients have late relapses even after 10 years of follow-up. Consequently, in this population, there is a strong yet unmet clinical need for reduce the risk of relapse, of progression and of death “.

The crucial role of lifestyle

It is also crucial to limit the risk of relapses the lifestyle of women: an increasing number of international scientific studies have now demonstrated the crucial role that our habits play both in limiting the chances of getting cancer and in reducing the chances of relapse. It is important to follow healthy eating (the Mediterranean diet continues to be among those with the greatest health benefits), avoid overweight and obesity that promote cancer in many ways, do not smoke and exercise regularly (each according to their possibilities). The advantages deriving from gymnastics are many: it reduces the fatigue (chronic fatigue, a side effect of chemo and radiotherapy), nausea and anxiety states, improves mood, increases self-esteem.

November 30, 2021 (change November 30, 2021 | 19:26)

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