27.12.2013

Breast cancer drug market

This article discusses the different types of treatment for breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
For many people with breast cancer surgery is still the first type of treatment they will have. In an increasing number of cases very small cancers are picked up on mammogramAn imaging study of the breasts, for example, by X-ray. If the lump is relatively large compared with the size of the breast then it may be necessary to remove the whole breast to make sure the cancer is completely removed (a mastectomy). All patients having surgery to the breast will also have some of their armpit glands (lymph nodesSmall, rounded organs of the immune system that are distributed along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes.) removed as well. The pathology laboratory diagnostic team will find out if any lymph nodes have been involved. In some cases a drug can also be given to stop the ovariesFemale reproductive organs situated one on either side of the uterus (womb).
Where indicated (see unnecessary chemotherapy), the final one of our main four treatments is chemotherapy.
Now, not everyone will need all of these treatments and which ones you need will depend on the characteristics of your particular cancer and the risk of it coming back.
So, where are all these treatments leading and what will be the “next big thing”? For further information on the author of this article, Consultant Breast Surgeon, Mr Simon Marsh, please click here.
A team of researchers from the University of Texas MD Anderson Cancer Center in Houston, have found that patients suffering from inflammatory breast cancer (IBC) can benefit from conjugating radiation treatments with simvastatin, a drug commonly used to treat high cholesterol and prevent cardiovascular disease. The study, published in the peer-reviewed journal Stem Cells Translational Medicine, examined simvastatin radiosensitization of different types of breast cancer cell lines in vitro to understand the therapeutic benefits of statins in controlling postmastectomy radiation (PMRT) in IBC patients. Surviving breast cancer stem cells that develop resistance towards radiation and chemotherapy may be the underlying basis of IBC’s tendency to metastasize.
A recent study from Danish scientists renewed the interest in the capacity of statins to affect breast cancer — “Our curiosity was piqued by the Denmark study and we also began looking at statins and found they seemed to improve survival in IBC patients.
From the total patients using statins, only 11% had a local recurrence of cancer when compared to 24% of the non-statin using group, demonstrating the compound potential to sensitize tumors to radiation therapy.
Statins have been used for a long time to treat hypercholesterolemia, and their capacity to improve disease outcomes in breast cancer patients has been known for a while. Additional authors of this all-MD Anderson study entitled “Simvastatin radiosensitizes differentiated and stem-like breast cancer cell lines and is associated with improved local control in inflammatory breast cancer patients treated with postmastectomy radiation” include Lara Lacerda, Jay P. Disclaimer:Radiation Therapy News is strictly a news and information website about the disease. In the era of precision medicine, targeting the mutations driving cancer growth, rather than the tumour site itself, continues to be a successful approach for some patients.
The phase II clinical study included results from 51 patients enrolled at 10 centers around the world with progressive, radioactive iodine-refractory (RAI) papillary thyroid cancer and a BRAF mutation who were no longer responding to prior therapies. After a 15-month follow up, 16 patients from two cohorts had partial responses, with an overall response rate of 38 and 27 percent in each of the two cohorts.
BRAF mutations, which occur in about 40 to 50 percent of these patients, have been associated with aggressive tumours and decreased ability of tumours to respond to radioactive iodine, typically the first line of treatment in these patients. Patients are often cured by surgery, without or without RAI, but 50 percent of them with residual, recurrent or metastatic ultimately do not respond to RAI.
Vemurafenib joins other multi-targeted kinase inhibitors (MKIs) (sorafenib, lenvatinib) shown to be effective in this patient population; in spite of responses to these drugs, the responses are temporary and additional treatment options are needed. For the study, researchers enrolled a total of 51 patients between January 2011 and January 2013. Patients in cohort one (26 patients) had not been previously treated with MKIs, while patients in cohort (25) were treated with MKIs. In cohort one, 10 patients had a partial response to vemurafenib, and an additional nine achieved stable disease for at least six months, for a combined disease control rate of 73 percent.
In cohort two, which had patients that were heavily pretreated, six patients had a partial response, and six achieved stable disease for at least six months, for a combined disease control rate of 54.5 percent. Overall, the side effects experienced by the patients were consistent with that of melanoma patients, except for the higher rates of weight loss, dysgeusia (distortion of taste), anaemia (lack of iron), increased creatine levels, and hepatic laboratory abnormalities. Please note - by subscribing to this newsletter you are confirming that you are a healthcare professional working within oncology or an aligned specialty. A group support program for young people dealing with a parent’s cancer is being run online for the first time tomorrow night with participants from Sydney, Melbourne, Wagga Wagga, Ipswich and the far north NSW coast. Developed by youth cancer charity CanTeen, Truce is a free, 7 week program for 14-22 year-olds whose parent or caregiver has cancer.
Truce Online will be run as a series of 1? – 2 hour webinars to allow time for both structured learning and for young people to share their experiences with each other.
Scientists from a reputed medical institution in Russia discovered that compounds extracted from parsley and dill seeds can restrict the growth of cancerous cells. Parsley and dill seeds contain apigenin, a naturally occurring, plant derived flavonoid, capable of killing up to 86 per cent of cancer cells. Dill seed oil has been termed 'chemoprotective', offering protection during exposure to daily carcinogens such as air pollution, car exhaust and cigarette smoke among others. Before we consider some of the treatments available I want to make the important point that the treatment of breast cancer has improved dramatically over the years. There are, however, four basic types of treatment to consider: surgery, radiotherapy, endocrine treatment (such as Tamoxifen or other, similar, tablets) and chemotherapy.
This is to make sure that there is a good margin of normal tissue around the cancer so that it is completely removed.


In some people who have a large cancer it is possible to shrink it before surgery so that breast conserving surgery becomes possible and I will come back to that later.
The pathologist will work out the type of breast cancer (there are several different sorts) and its size as well as its grade (a measure of how quickly it seems to growing). They will measure the thickness of the surrounding normal tissue (the clearance) and look to see if there is any sign of the cancer getting into any bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. If you have breast conserving treatment alone then the chance of the cancer coming back in that breast can be as high as 20%. The treatment can go on for 3-6 weeks and is given from Monday to Friday with a break at the weekend. As we have seen 66% of breast cancers need hormones (specifically the female hormone oestrogen) to grow (they are called oestrogen receptor positive cancers). The drugs are given either into the veinA blood vessel that carries blood towards the heart. Different combinations have different names, such as FEC, CMF or AC depending on the drugs used. For example, if your cancer is not sensitive to oestrogen then you will not need any endocrine, or hormonal, treatment.
I think that surgery and radiotherapy will remain an important part of breast cancer treatment for many years yet. As such, a compound that can effectively radiosensitize these resistant cells is of extreme importance to prevent cancer recurrence. In this latest study, we took it a step further by examining the medical records of 519 women with stage III IBC who had undergone radiation treatment after mastectomy, comparing those who were taking simvastatin at the time of radiation with those who weren’t,” said Dr.
Furthermore, their safe toxicity profile alongside low commercial cost make them the perfect candidates for accessible adjuvant use in radiotherapy. Dried parsley contains apigenin in large quantities kill a variety of cancer cells including, breast, ovarian, lung, pancreatic, prostate, and colon. The enzyme glutathione-S-transferase, present in dill aids in attaching the molecule glutathione to oxidized molecules thus making them antioxidants. They a rich source of Vitamin A and E, beta-carotene (which protects skin) and also contain a high amount of antioxidants.
I will go through each in turn and then also discuss some of the newer, molecular, treatments that are becoming available, as well as looking to the future to see what might happen in the years to come. If a mastectomy is needed then it is possible to rebuild the breast at the same time (immediate reconstruction).
In all cases the armpit glands will be looked at with an ultrasound scan before surgery and if any abnormal looking glands are seen a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope.
External radiotherapy, such as this, does not make you radioactive and it is quite safe to continue to be with other people. In these cases blocking the effects of oestrogen or preventing the body from making oestrogen can reduce the chances of the cancer coming back. These drugs work by killing cells that are dividing, and as cancer cells tend to be dividing more quickly than normal cells they are more likely to be killed. Although the side effects can be unpleasant they are often well controlled with other tablets.
If you have other potentially serious medical problems that may make a general anaesthetic dangerous then surgery may not be appropriate (although some lumps can be removed with local anesthetic).
The aim is to shrink a large cancer, which would normally require a mastectomy, to a smaller lump which can be treated by wide local excision. The advances will come in how we decide on which particular drugs are useful for each cancer. Wendy Woodward, IBC, MD Anderson, PMRT, radiation therapy, simvastatin, statins, stem cells.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
According to recent medical studies, Lycopene, a naturally occuring chemical present in tomatoes can effectively reduce risk of prostate, lung, mouth and throat cancer. The aim is to remove the cancer with a rim of normal breast tissueA group of cells with a similar structure and a specialised function. In some cases, when the lump is analysed down the microscope it seems to go further than expected and some people will need another operation to remove more tissue to get a safe margin of normal tissue.
They can also test to see whether the cancer needs oestrogenA hormone involved in female sexual development, produced by the ovaries.
It is also sometimes used after a mastectomy if the cancer has a high risk of recurring and it may be used in the armpit if only a few glands have been removed and they are found to contain cancer cells.
If you have not yet been through the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. If you have already been through the menopauseThe time when a woman's periods permanently cease.
However, as normal body cells can be dividing too they can also be affected, leading to side effects. Side effects include tiredness, nausea and vomitingExpusion of the contents of the stomach through the mouth., sore mouth, hair loss and effects on the nervesBundles of fibres that carry information in the form of electrical impulses. They pick up molecules from the blood or the fluid around the cells and as they do so they get activated or turned on.
The advantage of this is that you can actually see the chemotherapy work as the lump gets smaller and you know that you are having the correct combination of drugs. We have already started this in a limited way with Tamoxifen and then Herceptin and now the PARP inhibitors.


This means that many different things have to happen over a period of time for a breast cancer to develop. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Similarly the 10 year survival rate was only 40% in the 70s and it is now 80%, with a twenty year survival rate of nearly 70%. In some cases an ultrasound scanner is used and a mark is made on the skin (with a permanent marker) over the top of the cancer so that the surgeon knows where it is.
If the surgeon takes these cavity shavings at the time of the initial operation the proportion of people needing another operation is around 5%. In many cases a breast surgeon and a plastic surgeon will work together, one helping the other with their part of the operation. Once a receptor is turned on in this way it sends a message into the cell where it can produce various effects such as telling the cell to grow and divide.
Sometimes, if the lump does not shrink, you will be given a different combination of drugs.
Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The fundamental fact is that most people will no longer die from their breast cancer; and the treatments continue to improve.
This is also called a wide local excisionThe removal of a piece of tissue or an organ from the body., or sometimes (not strictly correctly) a lumpectomy. In about one third of cancer cells a receptor called the epidermal growth factorA chemical that stimulates new cell growth and maintenance in the body. Occasionally chemotherapy will not shrink the lump and a mastectomy will still be needed, but usually this works very well and sometimes the cancer can be too small to feel after the chemotherapy has finished. It is already possible to analyse a breast cancer to look for a wide range of abnormal genes. While the causes remain obscure, the treatments continue to improve and we can be optimistic about further developments in the future.
For this reason you will usually have a tiny metal marker clip placed into the cancer after the first or second cycle of chemotherapy. In the future we should be able to work out which particular drugs are required for each abnormal gene we find so that instead of simply knowing that chemotherapy is needed we will be able to specify exactly which drugs should be used for each individual cancer.
Sometimes a simple implant can be used, in other cases muscleTissue made up of cells that can contract to bring about movement. If the glands look normal then a sentinel lymphA watery or milky bodily fluid containing lymphocytes, proteins and fats.
Many oncologists use computer based and on-line assessment tools to help them work out the potential benefits of the different forms of treatment for each individual so that the pros and cons can be discussed fully before deciding on what treatment is needed. This type of drug is known as an aromatase inhibitor or AI and they do not work in premenopausal women. There are many different sorts of drugs that are used and several different drugs will usually be given in combination to produce a better effect.
Herceptin sticks to this abnormally active receptor and turns it off and kills the cancer cell.
This can be done either with ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. Lymph accumulates outside the blood vessels in the intercellular spaces of the body tiisues and is collected by the vessels of the lymphatic system. Whatever kind of endocrine tablet you have you will normally have a single tablet a day for 5 years. Tamoxifen is also a type of molecular treatment as it acts on the oestrogen receptor on the cell in a similar way.
If the cancer then becomes too small to feel, or even to see on a mammogram it is still possible, because of the clip, to find and remove the area of the breast that the cancer came from. Breast reconstruction can also be done at a later date (a delayed reconstruction) if that is what you want. The most common side effect of Tamoxifen is weight gain whilst the aromatase inhibitors can make the joints and muscles ache. The area may need to be localised in a similar way to small cancers that are detected on mammogram x-rays, using a guide-wire.
Then, with a general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body., the area of the breast with the wire in it is removed. Having said that, most women have few, if any, side effects and they tolerate the tablets very well.
These may be useful in breast cancers that are not sensitive to Tamoxifen or Herceptin or in those cancers due to an abnormal gene that runs in the family (the so called breast cancer genes, BRCA1 or BRCA2). If these glands do not show any signs of cancer cells then it can be considered that it has not spread and no more glands need to be removed.
Much research is going on to try and identify more of these types of treatment for breast cancer and I will come back to where this may lead later. If however they unexpectedly contain cancer cells then it allows the surgeon to remove more glands at the initial operation rather than having to wait at least a week for the results and then having to plan a second operation for a later date, which can then delay other treatments that may be needed.



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