HOW IS BREAST CANCER TREATED?
One of the keys to success when treating breast cancer is the speed with which the best treatment regimen is established. In less than a week, patients at the Clínica are diagnosed and can start with the administration of the most appropriate treatment for their case.
In addition to conventional treatment, our objective is to offer the most innovative treatments.
We conduct clinical trials that represent new opportunities for overcoming this disease, such as immunotherapy with active vaccines prepared in the Clínica's GMP laboratory. These vaccines stimulate the patient's immune system so that it can recognise the tumour cells and promote their destruction.
This surgical treatment is indicated for 70% of cases, because it is the least aggressive and does not require the complete extirpation of the breast.
Its objective is to eliminate the tumour while preserving the breast. This surgical procedure generally does not require hospitalisation.
The survival rates are equal to those achieved with the combination of mastectomy and radiation therapy.
In 30% of cases, the entire breast must be removed.
- Simple mastectomy. The surgeon extracts all the tissue from the breast and nipple. This procedure requires hospitalisation in most cases and may be combined with other treatments.
- Modified radical mastectomy. This consists of the extirpation of all breast tissue, nipple and some axillary lymph nodes. This procedure requires hospitalisation in most cases and may be combined with other treatments.
This diagnostic technique is performed at the same time as the surgery. In some cases, extirpation of the axillary lymph nodes is avoided. The technique consists of extracting the first tumour-draining lymph node, known as the sentinel node, for laboratory analysis. If the node contains no malignant cells, the rest of the axillary lymph nodes are not extracted.
This procedure offers physicians highly valuable information and entails fewer risks for the patients than other procedures.
During the same surgical procedure in which the tumour or the breast is removed, breast reconstruction techniques can be performed, offering the best solution with the least potential sequelae for the patient.
Postoperative radiation is essential because it reduces the risk of local recurrence by one-third.
Our specialists have extensive experience in both conventional radiation therapy (radiation of the full breast for 6 weeks) and partial radiation therapy, with radiation only in the bed of the tumour for just 5 days.
It has been shown that, for breast tumours in early stages, performing partial radiation therapy restricted to the area of risk (tumour bed) achieves highly satisfactory results, with a minimum risk of recurrence.
For this reason, the Clínica has launched several partial breast radiation techniques:
1.- Perioperative high-dose-rate brachytherapy: Offers significant advantages for the patient given that it can be performed in only 5 days, rather than the normal 6 weeks of treatment, and can be performed during the surgery to extirpate the tumour.
We are an international reference centre for this technique and have the greatest accredited experience in the performance of this minimally invasive intraoperative implantation for the administration of brachytherapy during the postoperative period.
Once the treatment has been completed, the catheters are easily withdrawn in the doctor's office and without the need for anaesthesia.
2.- Perioperative high-dose-rate brachytherapy plus external radiation therapy with forward-planned technique: For patients whose cancer is more disseminated, we apply a combination of radiotherapy treatments. Firstly, brachytherapy is administered directly on the area of greatest risk and is later supplemented by external radiation therapy on the entire remaining tissue breast.
3.- External radiation therapy with forward-planned technique: This radiation therapy technique offers more advantages than the conventional radiation therapy technique. It is administered in a more homogeneous manner, decreasing the acute adverse effects. Thus, the treatment can be administered in 15 sessions rather than the 25 necessary in conventional treatment.
Chemotherapy can be administered adjuvantly (after the breast cancer surgery), neoadjuvantly (before the breast cancer surgery) and in disseminated disease to control distant metastases.
Adjuvant therapy is used for localised tumours, as assistance for local treatments for controlling the disease. Its aim is to eradicate the circulating tumour cells and micrometastases.
Neoadjuvant therapy attempts to start the systemic treatment as soon as possible, assess the in vivo response of the tumour to treatment (determining whether the tumour is sensitive to and decreases with chemotherapy) and decrease the size of the tumour to increase the effectiveness of conservative surgeries, remove the smallest possible breast area and hopefully make the tumour operable.
The Clínica has specific protocols and extensive experience in the administration of chemotherapy during pregnancy.
We currently have an extensive range of antitumour chemotherapy agents for breast cancer.
The selection of the most appropriate chemotherapy regimen will depend on the size of the tumour, lymph node involvement, the presence of distant metastases, previous treatments, the breast cancer tumour subtype (based on the expression of receptors of oestrogens, progesterone, HER2, etc.), age, comorbidity, the patient’s functional status and the potential toxicities.
This is the first specific therapy for breast cancer and it is prescribed for tumours that express oestrogen receptors.
These types of tumours are the most common, accounting for 70%-80% of breast cancers.
Hormonal therapy has been shown to be beneficial because it decreases the risk of recurrence and increases the survival of patients with this hormone-sensitive disease.
There are various drugs for hormone therapy such as the selective oestrogen receptor modulators (tamoxifen), aromatase inhibitors (anastrozole, letrozole, exemestane), the luteinizing hormone-releasing hormone analogues (goserelin, triptorelin), oestrogen receptor antagonists (fulvestrant) and progestogens (megestrol acetate and medroxyprogesterone).
Extirpation of the ovaries (oophorectomy) can also be performed to reduce the body’s production of oestrogens. The main determinant for selecting the most appropriate hormone therapy in these patients is the functional condition of ovaries. To this end, patients are divided according to their menopausal status, through a medical history review and by reading the blood levels of hormones produced by the ovaries.
During antitumor hormone therapy, it is important to monitor patients through gynaecological examinations (cytology and ultrasonography) and measurements of bone mineralisation levels (densitometry) and blood cholesterol levels.
Currently, the use of this hormonal therapy is being planned as a preventive measure for patients who have not developed breast cancer but have been diagnosed with premalignant breast lesions (atypical hyperplasia).
The immune system is essential in the development and management of tumours. The goal of immunotherapy is to stimulate or repair the patient’s immune system so that the body itself can fight against the cancer.
Vaccines are prepared with cells from patients, to achieve an immune system response against the tumour. Limited disease and the combination of immunotherapy and chemotherapy makes this a good added option to the treatment of patients with breast cancer with localised disease and who need to undergo chemotherapy.
Tolerance to the procedure is good because the vaccines are prepared with cells from the body itself and are therefore not rejected. It is also an individualised treatment that can be administered along with chemotherapy for an extended period of time during the first 5 years, a period in which it is more likely that the disease will reappear.
It is not an isolated therapy but instead complements the patient’s standard cancer treatment with a vaccine schedule lasting two years.
The vaccines are prepared in the Clínica's Cell Therapy GMP laboratory [SP] with cells extracted from the patients. Once the cells have been processed, the patient’s tumour antigens are obtained from the cells.
The Clínica has performed a clinical trial to determine the effectiveness of the administration of autologous vaccines directed at reducing the progression of breast cancer in a specific subgroup of this disease in which the tumour cells do not express the protein HER2. Currently, the Clínica offers these vaccines as compassionate treatment supplementary to standard treatment.
At present, we have various drugs that act on tumour cells, either on the extracellular or intracellular level.
HER2 is a receptor protein that is present in some tumours and causes the tumours to grow more actively. A number of breast tumours overexpress this protein and can be treated with HER2 receptor inhibitors. This treatment has been shown to be highly effective in combination with chemotherapy, improving tumour response and patient survival.
Currently, trastuzumab and lapatinib have been marketed, and there are new drugs in the development phase, including pertuzumab and trastuzumab-DM1.
Lastly, antiangiogenic drugs impede the formation of abnormal vessels that provide nutrients to the tumour and promote its growth and metastasis. The addition of bevacizumab to chemotherapy has been shown to delay the progression of the disease in patients with distant metastases.
The Clínica continues researching new therapies in order to increase their effectiveness and reduce toxicity.