CANCER

             Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiationtherapy uses a machine outside the body to send radiation toward the cancer. Internal radiationtherapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stageof the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into avein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogento grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.

For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastaticbreast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.

See Drugs Approved for Breast Cancer for more information.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitorsare two types of targeted therapies used in the treatment of breast cancer. PARP inhibitors are a type of targeted therapy being studied for the treatment of triple-negative breast cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given byinfusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.

Trastuzumab is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which sends growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.

Pertuzumab is a monoclonal antibody that may be combined with trastuzumab and chemotherapy to treat breast cancer. It may be used to treat certain patients with HER2-positive breast cancer that hasmetastasized (spread to other parts of the body).

Ado-trastuzumab emtansine is a monoclonal antibody linked to an anticancer drug. This is called an antibody-drug conjugate. It is used to treat HER2-positive breast cancer that has spread to other parts of the body or recurred (come back).

Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy.

Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteinsinside tumor cells. It may be used with other drugs to treat patients with HER2-positive breast cancer that has progressed after treatment with trastuzumab.

PARP inhibitors are a type of targeted therapy that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied for the treatment of triple-negative breast cancer.

See Drugs Approved for Breast Cancer for more information.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Ductal Carcinoma In Situ (DCIS)

Treatment of ductal carcinoma in situ (DCIS) may include the following:

·         Breast-conserving surgery and radiation therapy with or without tamoxifen.

·         Total mastectomy with or without tamoxifen.

·         Breast-conserving surgery without radiation therapy.

·         Clinical trials testing breast-conserving surgery and tamoxifen with or without radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withductal breast carcinoma in situ. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Lobular Carcinoma In Situ (LCIS)

Treatment of lobular carcinoma in situ (LCIS) may include the following:

·         Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is called observation.

·         Tamoxifen to reduce the risk of developing breast cancer.

·         Bilateral prophylactic mastectomy. This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.

·         Clinical trials testing cancer prevention drugs.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withlobular breast carcinoma in situ. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer

Treatment of stage I, stage II, stage IIIA, and operable stage IIIC breast cancer may include the following:

·         Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.

·         Modified radical mastectomy with or without breast reconstruction surgery.

·         Sentinel lymph node biopsy followed by surgery.

Adjuvant therapy (treatment given after surgery to lower the risk that cancer will come back) may include the following:

·         Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.

·         Chemotherapy with or without hormone therapy.

·         Hormone therapy.

·         Monoclonal antibody therapy with trastuzumab combined with chemotherapy.

·         A clinical trial of new targeted therapies.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage I breast cancer, stage II breast cancer, stage IIIA breast cancer and stage IIIC breast cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IIIB, Inoperable Stage IIIC, Stage IV, and Metastatic Breast Cancer

Stage IIIB and inoperable stage IIIC breast cancer

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:

·         Chemotherapy.

·         Chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional therapy (chemotherapy, hormone therapy, or both) may be given.

·         Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Stage IV and metastatic breast cancer

Treatment of stage IV or metastatic breast cancer may include the following:

·         Hormone therapy and/or chemotherapy with or without trastuzumab.

·         Monoclonal antibody therapy with trastuzumab and pertuzumab combined with chemotherapy.

·         Antibody-drug conjugate therapy with ado-trastuzumab emtansine.

·         Tyrosine kinase inhibitor therapy with lapatinib combined with capecitabine.

·         Radiation therapy and/or surgery for relief of pain and other symptoms.

·         Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.

·         Clinical trials testing new chemotherapy and/or hormone therapy.

·         Clinical trials of new combinations of treatments, including targeted therapy, hormone therapy, and chemotherapy.

·         Clinical trials testing other treatments, including high-dose chemotherapy with stem cell transplant.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage IIIB breast cancer, stage IIIC breast cancer and stage IV breast cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Inflammatory Breast Cancer

Treatment of inflammatory breast cancer may include the following:

·         Chemotherapy.

·         Chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional therapy (chemotherapy, hormone therapy, or both) may be given.

·         Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withinflammatory breast cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Triple-Negative Breast Cancer

Treatment of triple-negative breast cancer may include the following:

·         Chemotherapy followed by surgery (breast-conserving surgery, total mastectomy, or modified radical mastectomy) and lymph node dissection.

·         A clinical trial of combination chemotherapy with drugs that are often used to treat breast cancerand drugs that are not usually used to treat breast cancer.

·         A clinical trial of PARP inhibitor therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withtriple-negative breast cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Breast Cancer

Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast orchest wall may include the following:

·         Surgery (modified radical mastectomy), radiation therapy, or both.

·         Chemotherapy or hormone therapy.

·         Antibody-drug conjugate therapy with ado-trastuzumab emtansine.

·         A clinical trial of trastuzumab combined with chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withrecurrent breast cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.