Breast cancer care is changing quickly. Over the past few years, many new treatments have been approved, and physicians can now match therapies more precisely to the features of an individual’s breast cancer subtype.
Below are some highlights. Please keep in mind that this is general information, not medical advice. Your own care team is the best source for guidance on what applies to you.
The Big Picture: Breast Cancer Is Not One Disease
Treatment depends on three main features of the tumor:
- Hormone receptors (estrogen and progesterone receptors): Whether the tumor is fueled by estrogen or progesterone.
- HER2 status: Whether the tumor produces a protein called HER2.
- Triple-negative breast cancer: A specific subtype that does not have estrogen receptors, progesterone receptors, or HER2 overexpression.
A major shift in recent years has been the growth of personalized, biomarker-guided treatment, especially for patients with advanced disease that has spread beyond the breast.
Physicians can test tumor tissue and, in some cases, blood samples for specific genetic changes to help select the medicines most likely to work. Testing for inherited genetic changes, such as BRCA1 and BRCA2, is also part of routine care.
Hormone Receptor-Positive, HER2-Negative Breast Cancer
This is the most common breast cancer subtype.
1. Medications that block cancer cell growth (CDK4/6 inhibitors)
- Ribociclib, abemaciclib, and palbociclib are used alongside anti-estrogen medications.
- These drugs play an important role in treating certain patients with higher-risk, early-stage breast cancer.
- They are also used to treat advanced breast cancer that has spread beyond the breast.
2. New targeted medications for resistant cancers
When standard anti-estrogen medications stop working, newer drugs can target specific pathways involved in cancer growth.
Examples include medications targeting changes in PIK3CA, AKT1, or PTEN, such as inavolisib, capivasertib, alpelisib, and gedatolisib.
3. New oral anti-estrogen medications (oral SERDs)
Some tumors develop an ESR1 mutation that makes them resistant to standard hormone therapy.
Newer oral medications, including elacestrant, imlunestrant, camizestrant, and vepdegestrant, offer additional treatment options for certain patients.
One recent advance is the use of blood tests to detect ESR1 mutations, potentially allowing physicians to change treatment before the cancer visibly grows.
HER2-Positive Breast Cancer
1. Antibody-drug conjugates
These targeted medications act like “smart” treatments, delivering chemotherapy directly to cancer cells.
Trastuzumab deruxtecan has become an important advance and is being used in earlier-stage breast cancer settings, including certain patients at high risk of recurrence after surgery.
2. First-line treatment for advanced disease
Recent clinical trial results from DESTINY-Breast09 support the use of trastuzumab deruxtecan combined with pertuzumab as a treatment option for advanced HER2-positive breast cancer.
3. Treatment for cancer that has spread to the brain
Newer HER2-targeted medications can reach cancer that has spread to the brain more effectively than some older treatments, expanding options for certain patients.
Triple-Negative Breast Cancer
1. Immunotherapy
Pembrolizumab is a medication that helps the body’s own immune system fight cancer.
It is now used to treat certain patients with high-risk, early-stage breast cancer, alongside chemotherapy before and after surgery. It is also used for advanced breast cancer when the tumor tests positive for a marker called PD-L1.
2. New treatment combinations
For patients with advanced, PD-L1-positive disease, combining the antibody-drug conjugate sacituzumab govitecan with pembrolizumab has shown improved outcomes in clinical trials.
3. PARP inhibitors
For patients with inherited BRCA1 or BRCA2 gene changes, PARP inhibitors such as olaparib and talazoparib are effective targeted treatment options.
Other Important Trends in Breast Cancer Care
Less treatment when appropriate
For some lower-risk breast cancers, the goal is to avoid unnecessary treatment. Genetic testing can help physicians determine whether certain patients can safely skip chemotherapy or radiation. Some patients may also be candidates for less extensive lymph node surgery.
Blood testing to monitor cancer
Testing for circulating tumor DNA (ctDNA) is an emerging tool that looks for tiny amounts of tumor DNA in the blood. It may eventually help physicians monitor recurrence risk and guide treatment changes.
A greater focus on survivorship
Newer guidelines place greater emphasis on quality of life, including managing symptoms and side effects related to treatment.
The role of diet and exercise
Research suggests that regular exercise may have beneficial effects on cancer-related outcomes. A diet centered on whole foods may also support overall health. Research into dietary patterns and cancer outcomes continues to evolve, and individual recommendations should be discussed with a healthcare professional.
A Note for Patients
Breast cancer treatment continues to evolve, with new therapies and testing approaches helping physicians tailor care to each patient’s diagnosis. Treatment decisions depend on many factors, including the cancer subtype, stage, genetic markers, overall health, and personal preferences.
Talk with your care team about which tests and treatment options may be appropriate for you.
This article is for general informational purposes only and is not intended to replace medical advice from your healthcare provider.