5 Breakthrough Breast Cancer Treatments.

As an academic medical center and comprehensive cancer program, we lead innovative research and clinical trials that allow us to provide the most cutting-edge treatments available and truly make a difference in our patients’ lives. Three areas of care experiencing significant progress include:

• Medical oncology
• Radiation
• Surgery

Breast cancer survival rates continue to improve along with our understanding of the disease. I’m excited to share how five recent innovations are helping our patients live longer and more comfortably.

1. Medical oncology: New treatments reduce cancer recurrence.

The number of drugs securing FDA approval to treat all types of breast cancer is increasing. One in particular— Enhertu—will drastically change treatment for patients with HER2-positive breast cancer, an aggressive type that grows quickly and has a high risk of recurrence. It affects up to 20% of all breast cancer patients.

Twenty years ago, advanced HER2-positive breast cancer was the worst kind of breast cancer to have. And now we’re probably not too far from turning it into a chronic disease.

HER2-positive cancer is diagnosed by cancer cells with high levels of a protein called HER2, which promotes cancer cell growth. Typical treatment to slow the growth of cancer combines HER2 targeted antibodies, which block HER2 protein growth, and chemotherapy. 

This combination has been shown to increase survival rates to more than five years, but after about 18 months half of patients require a second line of treatment. They then usually receive a drug that stops the cancer’s progression for only an additional six to nine more months.

Now, a new prescription medication that is approved as a third line treatment may become an alternative second line of treatment: trastuzumab deruxtecan, sold as Enhertu. It can stop cancer progression for many months over the previously approved second-line treatment. MedStar Health participated in the clinical trials for Enhertu; several women have received it and remained progression free for over two years.

Second PARP inhibitor receives FDA approval.

Following surgery, chemotherapy, and radiation, patients with BRCA1 or BRCA2 genetic mutations may soon be offered an FDA-approved daily oral pill to reduce their risk of cancer recurrence. This drug—olaparib (Lynparza)—is called a poly ADP-ribose polymerase (PARP) inhibitor. It’s one of two PARP inhibitors approved specifically for advanced breast cancer in patients with BRCA1 or BRCA2 mutations. 

BRCA1 and BRCA2 genes produce proteins that assist cells with DNA repair. Mutations in these genes have been shown to increase cancer risk. When they cause cells to become cancerous, PARP inhibitors can further stop DNA repair proteins from helping the cancer cells repair and replicate.

Up to 5% of U.S. breast cancer patients have BRCA1 and BRCA2 mutations. However, many patients don’t even know they have these mutations and could benefit from PARP inhibitors because they haven’t received genetic testing.

As testing becomes vitally important, our cancer genetics program at MedStar Health is growing. We already recommend genetic testing for high-risk patients such as women who received a breast cancer diagnosis at a young age or have a family history of breast cancer. But I don’t think we’re too far from having so many treatments for gene mutations that many more women will benefit from genetic testing.

2. Radiation: A larger dose means fewer trips to the clinic.

In the past, patients with smaller, less aggressive tumors who received a lumpectomy (surgery to remove the tumors) received radiation for their whole breast for five or six weeks. 

Now, many patients can receive just one, larger dose of radiation during their lumpectomy. This treatment is called intraoperative radiation therapy (IORT) and is best suited for patients with early breast cancer and low risk factors for cancer recurrence.

IORT delivers incredible time-saving benefits by eliminating the need to continually drive to the clinic to receive small doses of radiation. This has been especially helpful for patients who don’t receive paid time off from work or are single parents.

3. Surgery: Lymph node transplants and time-saving technology.

Breast cancer often spreads to the lymph nodes, so patients who have breast cancer surgery often also have a lymph node under their arm removed and examined. If cancer is found, more lymph nodes may need to be removed.

An unfortunate but common long-term side effect of this process is lymphedema, or swelling in the arm. It’s caused by fluid buildup in the arm tissue that occurs when the lymphatic system is damaged. 

MedStar Health now has a plastic surgeon—Laura Tom, MD—who specializes in an innovative lymphovenous bypass surgery that relieves the swelling. Transferring lymph nodes from a healthy part of the body into the swollen arm helps the fluid drain appropriately.

More accuracy, fewer surgeries.

Wire localization is often used to pinpoint the location of abnormal breast tissue that can be seen in a mammogram but not felt by your doctor. To ensure your surgeon removes the right breast tissue, a radiologist first inserts a wire into the breast and uses imaging technology to guide it to and mark the abnormal tissue. Later that day, you’ll undergo another procedure to remove the tissue.

This method can be painful and uncomfortable. It also creates risk for less accuracy because the wire can be bumped or moved while the patient waits for surgery.

A newer technology—magnetic seed localization (Magseed)—can locate the cancerous tissue days before it’s removed. Guided by imaging, a radiologist inserts a tiny magnet into the tissue. It does not move, and a surgeon can easily find it with a magnetic-detecting instrument.

Magseed eases many patients’ anxiety; they’re not surprised by the location of their cancer the day it’s removed or upset by the sight of a wire protruding from their skin. And because the magnet stays in place, the surgeon is more likely to remove all of the abnormal tissue at once instead of performing another surgery to remove tissue that was missed the first time.

This technology can also be used to identify cancerous lymph nodes, reducing the amount of lymph nodes that are removed and the level of disruption to the lymphatic system.

4. Entering the next wave of research: Breast cancer and the brain.

When cancer spreads into other parts of the body, such as the bones, liver, or lungs, treatment can stop the progression for long periods of time. But sometimes it appears in the brain because most of the treatments we provide cannot cross into the brain; it has a very protective barrier. 

This is one of the biggest unmet needs for breast cancer patients, and new drugs are starting to fill the gap. A recent study showed that a combination of the drugs tucatinib, trastuzumab, and capecitabine resulted in better progression-free survival in HER2-positive breast cancer patients whose cancer had spread to their brain. 

This specific drug combination received FDA approval in 2020 and is available at MedStar Health. We also have two ongoing studies to further understand the benefits of this approach.