Lines of Therapy: New Drugs May Change MBC Treatment
Which therapy to use for the first, second or third line of treatment for metastatic breast cancer is now under rigorous research as more new therapies are available for treating MBC.
When to Use Surgery & Radiation to the Breast
Do you need surgery or radiation to the breast after an MBC diagnosis? See the current research on this important question.
HER2-Low Expressing: A New Subcategory of HER2-Negative Breast Cancer?
New research shows that stage 4 breast cancer with HER2-low expression can benefit from a new drug. Learn more.
PD-L1 Biomarker for Immunotherapy
To qualify for Tecentriq®-based immunotherapy, the cancer must test positive for the PD-L1 protein. Learn what researchers have found about PD-L1 and other biomarkers to identify patients suited for immunotherapy.
What is ER-Low Breast Cancer?
Did you know that some breast cancers can be defined as estrogen receptor low (ER-low) breast cancer?
When you’re first diagnosed, a pathologist runs a series of lab tests on the cancer cells to see what drives the breast cancer to grow. Estrogen receptor positive (ER positive) breast cancer cells have proteins that respond to signals from estrogen, telling the cells to grow. Your pathology report will tell you whether the cancer is ER positive, and how many cells in the tumor sample had estrogen receptors.
Right now, any breast cancer with at least 1% of tested cells showing estrogen receptors is considered ER positive. But researchers have found that ER positive cancers that have a low number of cells with estrogen receptors may respond differently to treatment. These breast cancers are called ER-low.
To learn more about reading your test results, understanding ER-low, and what current guidelines are for treating estrogen receptor low breast cancer, see below.
What Do My Test Results Mean?
- How to Read Hormone Receptor Test Results Breastcancer.org explains the two scales used to describe the number of estrogen receptors on cancer cells, and what different results mean.
What Do Current Guidelines Say?
- ASCO and CAP Release Updated Guideline on Estrogen and Progesterone Testing in Breast Cancer The ASCO and CAP guidelines state that every lab should define ER positive as at least 1% of tested cells showing estrogen receptors. They acknowledge ER-low as a distinct group, but for now, this group is treated the same as all other ER+ breast cancer.
Should ER Low Breast Cancers Be Treated With Hormonal Therapy?
- Prognostic and Predictive Value of Low Estrogen Receptor Expression in Breast Cancer This research team found that hormonal therapies may not work as well against ER-low breast cancers.
- Breast Cancer Guidelines Carve Out Category for Low ER Expression It’s unclear whether hormonal therapy is the best treatment option for ER low breast cancers because of a lack of research data. Experts say doctors should talk to people with ER low breast cancers about the pros and cons of getting hormonal therapy.
What Are The Treatment Options for ER-Low Breast Cancer?
- TNBC Clinical Trials For ER-Low Breast Cancer Breast cancers that have any number of estrogen receptors, including those defined as ER-low, are currently treated with hormonal therapies. But some clinical trials for triple negative breast cancer (TNBC) accept people with ER-low cancers. See trials on Metastatic Trial Search that are accepting participants who qualify as ER-low.
- Clinical Trials for ER Positive Breast Cancer People with ER-low breast cancer may also qualify for clinical trials for estrogen positive (ER+) breast cancer. See clinical trials for estrogen positive breast cancer on Metastatic Trial Search.
HER2 Positive Metastatic Breast Cancer Research Update
The treatment landscape for HER2 positive metastatic breast cancer has been rapidly evolving. Since February, the FDA has approved three new drugs to treat it: neratinib, tucatinib, and trastuzumab deruxtecan. More continue to look promising in clinical trials. Targeted therapies’ drugs that can attach to certain features of cancer cells have created more research avenues and may potentially lead to more treatment options.
To learn more about what it means to be HER2 positive, how the subtype is typically treated, the latest news in research, and what might be coming down the line, check out the information below.
What Does HER2 Positive Mean?
- Breast Cancer HER2 Status The American Cancer Society describes, in simple terms, what HER2 positive means and what test doctors use to determine whether a tumor is HER2 positive or HER2 negative.
How HER2 Positive is Typically Treated
- Targeted Therapy The National Breast Cancer Foundation explains what targeted therapy is and how it works.
- Targeted Therapy for Metastatic HER2 Positive Breast Cancer Cancer.Net provides a complete list of targeted therapies used to treat HER2 positive metastatic breast cancer (halfway down the page).
What’s New in HER2 Positive MBC
- For Metastatic HER2 Positive Breast Cancer, New Treatments Emerge The National Cancer Institute gives a breakdown of recent research findings and FDA approvals for HER2 positive MBC.
- Recent FDA Approvals for Metastatic Breast Cancer From Metastatic Trial Talk’s June issue, find information on the two most recent approvals for HER2 positive disease. (Note that a third, sacitizumab govetican, is for people with triple negative breast cancer only.)
- FDA Approves Nerlynx for HER2 Positive Metastatic Breast Cancer Breastcancer.org explains the FDA approval of neratinib (NERLYNX®) for HER2 positive MBC, a drug once only approved for early-stage breast cancer.
- New Data from HER2CLIMB Shows Tucatinib Prevents Progression of Brain Metastases Living Beyond Breast Cancer summarizes a new analysis of data that shows people treated with tucatinib (TUKYSA) for HER2 positive MBC with brain metastases went longer without the brain metastases growing.
- Experimental Pyrotinib and Xeloda Regimen Better Than Tykerb and Xeloda for Metastatic HER2 Positive Breast Cancer Breastcancer.org discusses recent trial findings suggesting that pyrotinib, a tyrosine kinase inhibitor, worked better at treating HER2 positive MBC than lapatinib (Tykerb®). It may also work against cancers that have stopped responding to trastuzumab (Herceptin®).
- Trastuzumab Deruxtecan in Previously Treated HER2-positive Metastatic Breast Cancer: Plain Language Summary of the DESTINY-Breast01 Study Future Medicine provides the results of a clinical trial testing trastuzumab deruxtecan, also known as T-DXd, for the treatment of HER2+ MBC. T-DXd is approved by the FDA for treatment of patients with HER2+ MBC who have received other previous treatments.
What’s in the Pipeline?
- Emerging Areas in Metastatic Breast Cancer Treatment Susan G. Komen breaks down treatments on the rise and under study for metastatic breast cancer. For HER2 positive disease, the most helpful sections are HER2 Targeted Therapies, HER2 antibody drug conjugates, and Tyrosine kinase inhibitors.
- Clinical Trials for HER2 Positive MBC Metastatic Trial Search provides a list of over 100 clinical trials for people with HER2 positive metastatic breast cancer.
See all articles on this site tagged with HER2 Positive breast cancer
Recent FDA Approvals for Metastatic Breast Cancer
June 2020
Recent FDA Approvals for Metastatic Breast Cancer
For the past two months, Metastatic Trial Talk brought you the latest about cancer and COVID-19. But while the world focused on coping with the pandemic, the Food and Drug Administration kept drug approvals moving. It approved in April two new medicines for metastatic breast cancer: tucatinib (Tukysa®), for HER2-positive disease, and sacituzumab govetican (Trodelvy®), for triple-negative disease.
Below, read about the FDA approval of each new medicine, who might benefit the most, how the treatments are given and what side effects each may cause. In addition, you’ll find information on the approval of a third drug, trastuzumab deruxtican (Enhertu®), announced in late December.
Tucatinib (Tukysa®)
- CURE: What You Need to Know About the FDA’s Approval of Tukysa for HER2-Positive Breast Cancer
- OncLive (video): HER2CLIMB: IMplications for Brain Metastases in HER2+ mBC
- BreastCancerTrials.org: Open Trials with Tucatinib That Are Recruiting Breast Cancer Patients
Sacituzumab govetican (Trodelvy®)
- Living Beyond Breast Cancer: FDA Approves Targeted Therapy for Metastatic Triple-Negative Breast Cancer
- BreastCancerTrials.org: Open Trials with Sacituzumab Govetican That Are Recruiting Breast Cancer Patients
Trastuzumab deruxtican (Enhertu®)
- OncLive (video): HER2+ mBC: Study Design and Results of DESTINY-Breast01
- Breastcancer.org: FDA Approves Enhertu for Unresectable or Pretreated Metastatic HER2-Positive Breast Cancer
- BreastCancerTrials.org: Open Trials with Trastuzumab deruxtican (DS-8201a) That Are Recruiting Breast Cancer Patients
Relevant Topics on Metastatic Trial Talk (MTT)
The Tumor Microenvironment
Scientists have discovered that the microenvironment–the cells that surround a tumor–plays a role in both how tumors grow and how they respond to treatment. Researchers also think that certain treatments, like immune checkpoint inhibitors, work in part because of the effect they have on the tumor’s microenvironment.
Below you will find articles and video presentations that discuss the microenvironment, different avenues of tumor microenvironment research scientists are pursuing, and clinical trials listed on BreastCancerTrials.org studying a treatment’s affect on a tumor’s microenvironment.
Tumor microenvironment
- Nature: The Tumor Microenvironment
- Addgene: The Breast Cancer Microenvironment: A Tumor’s Backstage Team
- Cold Spring Harbor Laboratory (Video): Battling Breast Cancer: Understanding the Tumor Microenvironment
Tumor microenvironment and MBC
- Share Cancer Support: Metastatic Breast Cancer and The Tumor Microenvironment
- Journal of Cancer Metastasis and Treatment: Breast Cancer, Metastasis and the Microenvironment
Tumor microenvironment related clinical trials
- Metastatic Trial Search: Metastatic Clinical Trials Targeting the Microenvironment
- National Cancer Institute (webinar by Dr. Alexandra Harris): What the tumor microenvironment is and how it is being studied to benefit people with cancer (skip to 29:00)
What is Your Tumor’s Mutation Burden?
The term “tumor mutation burden” refers to the number of mutations, or changes, seen in the DNA of your cancer cells. It is now one of the biomarkers used to determine cancer treatments. Studies suggest that tumors with a high number of mutations may be more likely to respond to a type of immunotherapy called a checkpoint inhibitor.
Below you can read more about how researchers are using tumor mutation burden to determine which treatments might be best for which patients. You will also find articles specific to studies that have looked at the relationship between tumor mutation burden and treatment outcomes in patients with metastatic breast cancer.
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- Cholangiocarcinoma Foundation: For Cancer Patients, Mutations Matter
- Scientific American: Tumor Mutation Burden: Unlocking Cancer’s Genetic Fingerprint
- Bristol-Myers Squibb: Tumor Mutational Burden (image)
- Biorxiv.org: Prevalence and mutational determinants of high tumor mutation burden in breast cancer
- OncLive: High TMB Metastatic Breast Cancer Responds to Pembrolizumab Monotherapy
- Cancer Research: Abstract 4894: Incidence of high tumor mutation burden (TMB) and PD-L1 positivity in breast cancers and potential response to immune checkpoint inhibitors (ICPIs)
- European Society for Medical Oncology: Perspectives from ASCO 2018: Tumor Mutation Burden, a Novel Biomarker (video)
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Triple-Negative Breast Cancer Update
For women and men with triple-negative breast cancer, chemotherapy has been the primary treatment option. But as scientists learn more about subtypes of triple-negative breast cancer, clinical trials can better match new targeted therapies with specific triple-negative patients. These advances are what led to the FDA approval in March 2019 of the PD-L1 inhibitor atezolizumab (Tecentriq®) to treat women and men with metastatic triple-negative breast cancer whose tumors test positive for PD-L1. And we can expect to see more trials that target specific subtypes of triple-negative cancer in the future.
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- Cancer Therapy Advisor: The First Targeted Therapy For PD-L1+ Metastatic Triple-Negative Breast Cancer
- Breast Cancer Research: Identification of Three Subtypes of Triple-Negative Breast Cancer
- Nature Research: A Novel Approach to Triple Negative Breast Cancer Molecular Classification
- Practice Update: Ladiratuzumab Vedotin Plus Pembrolizumab for Advanced TNBC
- Metastatic Trial Search: Find trials for metastatic triple negative breast cancer
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