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Medical Oncology in Breast Cancer
The treatment of breast cancer has continued to evolve over the last twenty years with
more bias towards treatments which are increasingly specific to the breast cancer subtype
and tailored to each individual pateint. Broadly, the treatments offered by Medical
Oncology are divided into three main categories: neoadjuvant, adjuvant and metastatic.
Neoadjuvant treatment is delivered prior to surgery to shrink the tumor tissue to facilitate
its easy removal and may sometimes result in a complete response where no tumor tissue
is identified at the time of surgery. Adjuvant therapy is in addition to the primary surgery
for early stage breast cancer where such treatments are geared towards targeting cancer
cells that are left behind and to minimize the risk of recurrence. Treatments for metastatic
disease are designed to achieve a high cancer cell kill with minimal side effects with a
goal of improving survival while providing a good quality of life.
The type of treatments used have also seen a paradigm shift as we continue to understand
the biology of breast cancer and the importance of approaching each patient mindful of
their unique clinical scenario. The treatments offered by Medical Oncology include
hormone (estrogen) manipulating agents termed endocrine therapy which include drugs
like Tamoxifen and anastrozole, biologic agents like trastuzumab and systemic
A combination of the endocrine, biologic and systemic chemotherapy are employed in
the neoadjuvant and adjuvant setting where the goal of treatment is to achieve a cure and
minimize the chance of recurrence in the patient’s lifetime. The same treatments are
employed sequentially or in combination (in some cases) in the metastatic setting where
these agents have been shown to maximize survival while minimizing side effects.
The side effects of the endocrine therapy are minimal with most women with estrogen
receptor positive tumors responding to these agents in terms of shrinkage of tumors even
in advanced stages and the duration of response with such agents can extend for years at
The biologic agents are newer to the current arsenal of drugs against breast cancer. These
fascinating molecules are engineered to target specific proteins selectively expressed on
or in the cancer cells while avoiding significant collateral damage to normal tissue. This
is an evolving branch of oncology which is sure to change our treatment approach as we
expand our knowledge of the breast cancer cell to the molecular level and beyond.
Systemic chemotherapy includes drugs that are designed to destroy or interfere with the
growth of the fastest growing cells in the body, which invariably are cancer cells. Some
tissues in our body like the bone marrow, gut and skin have cells that have to grow fast to
keep up with the normal turnover and this accounts for most of the side effects that we
encounter when patients are exposed to chemotherapy. Fortunately, our understanding of
the pharmacology of these drugs has also advanced over the years along with a marked
improvement in ancillary drugs that can minimize side effects from the chemotherapy.
The advancements noted above take years in the making and the backbone of such
progress are well designed clinical trials where these drugs/combinations are tested
against the current standard of care with an aim to better our cure rates and improve
survival for our patients. We are participating in over a hundred clinical trials at the
Mercy Cancer Center with a dedicated research staff and encourage trial participation for
eligible patients at all times.
The survival rates for advanced breast cancer continue to improve over time and with
each passing year, we hope to advance our knowledge about this disease, find the
strength to fight alongside our patients and the humility to recognize our own limitations
as we inch towards a cure.
Arvind Vemula, M.D.