Talk:Breast cancer management

Possibly copyright violation

I just barely split article out from main Breast cancer page. I will scan the article and try to rewrite/paraphrase where possible to avoid copy violation. Consider this a hang on tag for a couple hours until I can do this. Optigan13 05:51, 13 October 2007 (UTC)

You don't have to rewrite it, since the source is Wikipedia. You just have to attribute the parent article for GFDL compliance reasons. I'll do it below and on the article page. -- But|seriously|folks  05:53, 13 October 2007 (UTC)

LN as indication for XRT

I changed the XRT section from "4 or more LNs" (paraphrasing here) as an indication for post-mastectomy XRT (PMRT) to "substantial involvement" as an indication. The 4 or more recommendation is predominantly based on subset analysis from the randomized Danish PMRT studies. Similar subset analyses demonstrate that the 1-3 positive LN patients have the same relative survival benefit as those with greater numbers of LNs, even with 8 or more nodes removed (median in the study was 7 LN removed, and this has formed the basis for the argument that fewer LNs involved probably do not require PMRT if "adequate" surgery (10 or more nodes) is performed). Three randomized studies have shown a survival benefit for PMRT in node positive patients, while one has not. Thus, the NCCN advocates PMRT for all women with 4 or more nodes involved and "strong consideration" for women with 1-3 nodes involved. I feel the new wording is more permissive in allowing consideration of PMRT in all node positive patients (micromets or IHC excluded, hence the "substantial" wording) rather than just in those women with 4 or more positive nodes. Schwartzenator (talk) 04:47, 20 May 2008 (UTC)

Immuno Therapy

This section is a copy/paste of its source.--Mandor (talk) 14:12, 2 March 2009 (UTC)

No mention of Abraxane/Paclitaxel

Article doesn't seem to mention Abraxane (a formulation of Paclitaxel) which was approved by the FDA in 2005 for treatment of refractory breast cancer. Rod57 (talk) 19:51, 12 June 2010 (UTC)

Lymphedema section looks like a huge copy from somewhere

Includes lots of references at the end. No wikilinks. Is it worth editing or should it just refer to Lymphedema ? - Rod57 (talk) 21:53, 15 December 2015 (UTC)

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pipeline

The table and "preclinical" sections below were an ambitious effort by somebody to track the pipeline of drug candidates for breast cancer. Content is mostly unsourced or based on primary sources and outdated. Questionable whether this sort of detail belongs in WP per WP:NOTNEWS as well

Other types of targeted therapies that are being researched to fight cancer include:

• Angiogenesis inhibitors. These antibodies prevent the growth of new blood vessels, cutting off the supply of oxygen and nutrients to cancer cells.
• Signal transduction inhibitors. These antibodies block signals inside the cancer cell that helps the cells divide, stopping the cancer from growing.
• Antibodies/antagonists for other hormones/receptors such as androgen receptors and prolactin receptors, which are present in a high proportion of breast cancers.

Target	Drug	Type	Efficacy Trial
ER	Anastrozole (Arimidex) Letrozole (Femara) Exemestane (Aromasin)	Aromatase inhibitor
	Fulvestrant (Faslodex)	Other
AR in ER+ cancers	testosterone, synthetic androgens, progestins	androgen agonist
AR in ER- cancers	bicalutamide	androgen receptor antagonist	Phase II MBC testing underway
HER2 receptor protein	Trastuzumab (Herceptin) Pertuzumab neratinib (HKI-272) in Phase II	Monoclonal antibody
	lapatinib (TykerB)	Kinase inhibitor
PRLR	cabergoline	selective dopamine D2 and serotonin agonist reducing prolactin levels	very good results in pretreated MBC in combination with docetaxel
	NeuVax dHER2 MVF-HER-2	Vaccine	NeuVax is a HER2/neu peptide-based T-cell immunotherapy aimed at preventing disease recurrence and prolonging survival in cancer patients that have tumors expressing the HER2/neu oncoprotein. To date, clinical study results have demonstrated that NeuVax significantly reduces the rate of cancer recurrence while showing minimal side effects
	E1A (gene therapy) Trastuzumab emtansine (Herceptin+DM1)	Other
HER1/ EGFR	Iressa (gefitinib) Cetuximab	tyrosine kinase inhibitor	However, clinical studies did not find most EGFR inhibitors effective against breast cancer for a large enough proportion of patients. Some oncologists believe it may be possible to select a fraction of patients, either through genetics or the characteristics of their tumors, who have a better chance of having the drugs work
insulin-like growth factor-1 receptor (IGF-1R)	IMC-A12 CP-751, CP-871 AMG 479 h7C10	Monoclonal antibody
insulin-like growth factor-1 receptor (IGF-1R) and insulin receptor (IR)	Linsitinib (OSI-906)	Dual kinase inhibitor
PI3K/AKT/mTOR cell survival pathway	BGT226 BEZ235A RAD001 Rapamycin	Kinase inhibitor
VEGF receptor protein (involved in forming tumor blood vessels)	Bevacizumab (Avastin) ramucirumab	Monoclonal antibody	AVADO
	Sunitinib Vatalinib Pazopanib AZD2171 AMG706	Kinase inhibitor
	AMG386 PTC299	Other
P53	P53 peptide vaccine	Vaccine
	Gendicine (from China) d5CMV-p53 (INGN 201)	Gene therapy
	ALT801 (p53 inhibitor) Anti-p53 T-cell reinfusion AFP-464 (phase I for triple -ve)	Other
PARP protein inhibitor	Olaparib (Phase I with good results) Iniparib (Phase II excellent results) BSI-201 (Phase II - Clinical Benefit in 62% Of Patients With Triple-Negative) veliparib	DNA repair blocker - kills cancer cells with a faulty BRCA1 or BRCA2 gene by preventing the repair of DNA. A cell with a BRCA fault relies on a protein called PARP to keep its DNA healthy. Olaparib, known as a 'PARP-inhibitor', blocks PARP, which causes the cancer cells to die.	Olaparib - In the initial findings, Over 40% of tumours in the higher dose group reduced significantly in size, and tumours were prevented from progressing for an average of six months, while one patient's tumour disappeared completely in a heavily pre-treated set of patiens in an ongoning trail. BSI-201 - Among other investigational PARP inhibitors in the industry, BSI-201 is the furthest along in clinical development in metastatic TNBC. BSI-201 is currently being evaluated for its potential to enhance the effect of chemotherapy-induced DNA damage. The clinical development of BSI-201 is supported by well documented safety profile based on studies of more than 200 patients.
ATGR1 (ERBB2)	Losartan (blood pressure drug)	AGTR1 is seen in 10 percent to 20 percent of breast tumors. Specifically, overexpressed only in tumors that are HER2-negative and ER-positive. AGTR1 was found to be as much as 100-fold overexpressed in some tumors.
eIF4E gene	ribavirin (a common anti-viral drug)	eIF4E gene is dysregulated in 30 percent of cancers including breast, prostate, head and neck, colon and stomach cancer.	The trial studied patients with M4/M5 acute myeloid leukemia who had undergone several other treatments that had previously failed. They had striking clinical improvements with even partial and complete remissions.
Other Targets	Dasatinib (SRC inhibitor)	Kinase inhibitor	Drug already used to treat CML is a possible cure for a subset of breast cancer population who test positive for alpha-v beta-3.
	Saracatinib (SRC inhibitor)	Kinase inhibitor	Combining Herceptin and saracatinib to treat resistant tumors in mice reduced tumor volume by 90 percent in 25 days. Herceptin alone kept tumor volume about the same during the same period, while control and saracatinib alone permitted growth of more than 200 percent.
	Sorafenib (Nexavar)	multi-kinase inhibitor
	AS1402 anti-MUC1 antibody THERATOPE Dendritic cell vaccines	Vaccine - Stimuvax
	C1311 in phase II (topoisomerase II inhibitor) Bavituximab in Phase II	Other

Preclinical

Protein tyrosine phosphatase 1B (PTP1B)

In the March 2007, edition of the scientific journal, Nature Genetics, researchers from Canada's McGill University reported that they had developed a potential drug target for treating up to 40 percent of breast cancers by blocking an enzyme called protein tyrosine phosphatase 1B (PTP1B), which has been implicated in the onset of breast cancer in mouse models of the disease. Elevated levels of PTP1B have also been found in diabetes and obesity. A drug to block the activity of PTP1B is under development by Merck, and was found to delay the development of breast tumors and prevent lung cancer up to two months from the administration of the drug. The researchers hope to continue further research in mouse models which are also HER-2 positive (responsive to Herceptin) so that the drug could benefit a significant population of women.

Cholesterol drug - Ro 48-8071

It is possible that one mechanism utilized by PRIMA-1 to kill cancer cells may include shutting down cholesterol synthesis. What is now known is that Ro 48-8071 stops cholesterol synthesis, and it has been proved to be just as effective in destroying cancer cells as PRIMA-1, without harming other normal breast cells.

Antidiabetic

In experiments led by postdoctoral fellows Heather Hirsch and Dimitrios Iliopoulos, the combination of metformin and the cancer drug doxorubicin killed human cancer stem cells and non-stem cancer cells in culture. The researchers used four genetically distinct breast cancer cell lines.

In mice, pretreatment with the diabetes drug prevented the otherwise dramatic ability of human breast cancer stem cells to form tumors. In other mice where tumors were allowed to take hold for 10 days, the dual therapy also reduced tumor mass more quickly and prevented relapse for longer than doxorubicin alone. In the two months between the end of treatment and the end of the experiment, tumors regrew in mice treated with chemotherapy alone, but not in mice that had received both drugs. By itself, metformin was ineffective in treating tumors.

Thermochemotherapy

Modern advancements in hyperthermia biology have led to refinements for individualised thermochemotherapy approaches to treatments as well as interesting potential for exploiting hyperthermia in conjunction with cancer vaccines. MR imaging is playing an increasing role for measuring patient response to hyperthermia.

Interest in hyperthermia as a treatment for breast cancer has led to significant advances and research activity which, in turn, has had a significant impact on treatment protocol. The National Comprehensive Cancer Network (NCCN) now includes hyperthermia in their Breast Cancer Guidelines as a treatment for recurrent cancer.

Erasmus Medical Centre in the Netherlands is one of Europe's largest hyperthermia centres.

ThermoDox is a proprietary heat-activated liposomal encapsulation of doxorubicin, an approved and frequently used oncology drug for the treatment of a wide range of cancers including breast cancer. ThermoDox, which is administered intravenously and in combination with local hyperthermia, has the potential to provide local tumor control and improve quality of life. Localized mild hyperthermia (39.5-42 degrees Celsius) releases the entrapped doxorubicin from the liposome. This delivery technology enables high concentrations of doxorubicin to be deposited preferentially in a targeted tumor.

Flax

Testing of flaxseed (the highest source of mammalian lignans) on rats led to reduction and regression of tumours. This led to a formal randomized, placebo-controlled, double-blind study involving 32 postmenopausal patients confirming that 25g flaxseed daily intake significantly reduced cell proliferation, increased apoptosis and reduced c-erbB2 expression of human breast cancer cells. The preliminary research into flax seeds indicates that flax can significantly change breast cancer growth and metastasis, and enhance the inhibitory effect of tamoxifen on estrogen-dependent tumors.

[{reflist-talk}}

-- Jytdog (talk) 15:43, 10 October 2016 (UTC)

References

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