Therapy of breast carcinoma – What’s new?

  01. October 2021

Every year, an average of 6200 women and 50 men are diagnosed with breast cancer in Switzerland. Breast cancer is thus the most common form of cancer in women.

The annual consensus conference on this topic is held in St. Gallen, Switzerland, to gather the opinions of international experts on current therapy recommendations in the treatment of breast cancer.

This year’s theme, “Customizing local and systemic therapies for women with early breast cancer,” shows that today’s endeavor is to individualize therapy for the individual patient. Attention is paid not only to the interindividual differences of the diseased women, but also to the different characteristics of the different tumor subgroups.

In general, the treatment of early breast cancer consists of different procedures (surgery, radiation and drug treatment including chemotherapy and anti-hormonal therapy), which are combined depending on the patient and tumor subtype. After the diagnosis has been confirmed, a personal therapy concept is created. Increasingly, neoadjuvant therapy (i.e. drug therapy prior to surgery) is coming to the fore. The advantage of this form of therapy is the possibility of controlling the success of the therapy directly on the response of the tumor. The drugs used in therapy are increasingly targeted therapies in addition to established chemotherapies. In contrast to chemotherapy drugs, which primarily develop cell-damaging effects on all dividing body cells, the approach of targeted therapies is to damage, as far as possible, only molecules of tumor cells that play a significant role in tumor growth. In this area, new drugs are constantly being developed that intervene in the various signaling pathways of tumor cells.

The realization that breast cancer is a disease of the whole body, not just the breast, has made surgical therapy less and less radical in recent decades. In particular, the recommended extent of surgery in the area of the armpit has become steadily smaller and thus, whenever possible, “only” removal of the so-called sentinel lymph node or targeted removal of affected lymph nodes is performed. This approach has significantly reduced the number of women with marked lymphedema and nerve damage as a result of radical surgical techniques.

Two concepts are available for surgical treatment of the breast: removal of the entire breast together with the tumor or, if possible, breast-conserving surgery followed by radiation therapy of the remaining breast. Studies have shown that both concepts are equivalent in terms of therapeutic success. In the field of radiation therapy, too, there are frequent adjustments to the dose and therapy intervals. Thus, a so-called hypofractionation is currently recommended, in which fewer irradiations with higher individual doses are given in a shorter period of time. The research efforts are great in order to continuously improve the treatment in the future and so a large proportion of women are already surviving the disease in the long term.