Research into treating breast cancer
This page tells you about research into breast cancer treatment. You can find information about
- A quick guide to what's on this page
- Why we need research
- Checking the lymph nodes
- Gene tests to decide on treatment
- Chemotherapy side effects
- Hormone therapy
- Biological therapies
Research into treating breast cancer
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. We also need to know that they are safe.
First of all, treatments are developed and tested in laboratories. Once we know they are likely to be safe, they are tried in clinical trials in people. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.
For breast cancer, researchers are looking into
- Surgery, including new ways of checking lymph nodes and removing secondary cancers
- Hormone therapy
- Biological therapies
- Better ways of picking up a cancer that has come back
You can view and print the quick guides for all the pages in the Treating breast cancer section.
Research goes on all the time into how best to treat breast cancer. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials. Usually doctors test new treatments in people with advanced breast cancer first. If a new treatment helps with advanced breast cancer, it may work for early stage breast cancer. So doctors then test it in clinical trials to see if it lowers the risk of the cancer coming back.
Doctors would like to be able to identify who is most at risk of their breast cancer coming back. Then they can give treatment to those women and avoid giving treatment that may cause side effects to women who don't really need it. At the moment, we don't know for sure who is most at risk so research is looking into this.
Research into surgery for breast cancer includes
Surgeons in the UK and the rest of Europe are looking into keyhole surgery for early breast cancer. Keyhole surgery has been used in Japan for many years to take away breast tumours in women with small or medium sized breasts. In keyhole surgery, a small cut is made close to the breast and another cut close to the nipple. The surgeon passes a thin tube called an endoscope through the hole into the breast tissue. The tube has a small camera at the tip so the surgeon can see and remove the cancer cells.
Keyhole surgery gives less scarring than standard operations to remove the breast (mastectomy) or remove the breast lump (wide local excision). During the surgery an inflatable breast implant (prosthesis) can be put in through the cut to replace the tissue that the surgeon removes. After a mastectomy the implant is slowly inflated over a few weeks to give a normal breast shape. It is not yet clear whether this type of surgery is as good as standard breast surgery in getting rid of the cancer completely.
Doctors in the UK are starting clinical trials to compare keyhole surgery to standard surgery. This type of surgery needs specialist equipment and must be carried out by surgeons with specialist training. So it is only available at a few hospitals in the UK. The National Institute for Health and Care Excellence (NICE) has issued guidance that there is currently not enough evidence about how well keyhole surgery works for breast cancer. They say that this procedure should only be used as part of research.
Many women have reconstruction after a mastectomy. You may have this done at the same time as mastectomy or at a later date. You may have reconstruction using your own body tissue, or an implant to replace some or all of your breast tissue. Or you may have a combination of both these methods. These types of reconstruction have been used for some years and are safe. But doctors want to find out more about the advantages and disadvantages of each method, and whether certain women suit one way better than the other. The POBRAD-M trial is looking into this for women having immediate breast reconstruction.
Surgeons usually treat breast cancer with surgery to remove it. Sometimes the cancer has spread to the lymph nodes in the armpit (axilla) when it is diagnosed. To find out if the cancer has spread surgeons usually remove the lymph node most likely to contain cancer cells (sentinel node biopsy) at the same time as removing the breast cancer.
The MagSNOLL study is looking at using a magnetic substance to show up very small tumours in the breast and to find the sentinel lymph nodes under the arm. Researchers have developed a device called a magnetometer that can detect a magnetic tracer injected into the breast. They want to see if is possible to see both the breast cancer and the sentinel lymph nodes with a single injection of the tracer.
Some research is looking into a new way of checking whether the cancer has spread into the lymph nodes under the arms. It is called endoscopic axillary lymph node retrieval. The surgeon needs to have specialist training in the technique. They make very small cuts in the skin of the armpit and put in tiny tubes and special instruments. Liposuction removes any excess fat in the area and the surgeon then takes out some lymph nodes. NICE recommends that currently this procedure is only used in research trials.
For women whose lymph nodes contain cancer cells, the AMAROS trial looked at whether radiotherapy to the armpit, or surgery to remove these lymph nodes, is the best way to stop the cancer coming back. The research team found that radiotherapy was as good as surgery in preventing the cancer from coming back in the lymph nodes. They found that the side effects of treatment were similar in both groups, but more women who had surgery developed swelling of the arm (lymphoedema). You can read the results of the AMAROS trial on our clinical trials database.
The MISO BC trial is looking at whether CT scans of the armpit before surgery can show if breast cancer has spread into the lymph nodes. It would be very helpful if the scans can show before surgery whether the breast cancer has spread or not. It would mean that women would only need to have 1 operation instead of 2 operations. This trial has closed and we are waiting for the results.
Some trials are looking at genes before or during treatment to see if particular genes affect how treatment works.
The MINDACT trial is looking into whether genetic testing can help to decide who should have particular types of treatment after surgery for early breast cancer. These are called genomic tests. The OPTIMA trial is seeing whether a gene test called Oncotype DX can safely predict whether a woman needs chemotherapy to treat her breast cancer. These trials have closed and we are waiting for the results.
The NEO study is looking at predicting how well breast cancer is likely to respond to chemotherapy before surgery.
You may have heard about a research study called METABRIC. This study, funded by Cancer Research UK, has been looking at other changes in the genes of breast cancer cells. Recently published, the research shows that there are at least 10 different subtypes of breast cancer. These subtypes are based on particular gene changes in the breast cancer cell.
The researchers hope that in the future the information about subtypes will help doctors to decide how much treatment each person needs. It may also help them to know which types of treatment the cancer is most likely to respond to. This research is at an early stage and tests are not available at the moment. It will be some years before it changes the treatment people have for breast cancer. You can find out more about this study on our science blog.
There is an enormous amount of research going on into breast cancer chemotherapy. You can find detailed information about chemotherapy trials for breast cancer on our clinical trials database.
This page includes information about
- New chemotherapy drugs and combinations
- Monitoring effects of treatment
- Protecting the ovaries during treatment
- Using chemotherapy with biological therapy drugs
- Chemotherapy for triple negative cancers
Doctors are continually trying to find new chemotherapy drugs to improve breast cancer treatment. They also try to find better ways of using current chemotherapy drugs such as giving them more often or in different doses.
Some of the new drugs and combinations being used after breast surgery in trials include
- A new type of paclitaxel called Abraxane
- Vinflunine (Javlor)
- Gemcitabine and paclitaxel (GemTaxol)
- Liposomal doxorubicin
- Eribulin mesylate (made from natural sea sponge),
Some people have chemotherapy before surgery to shrink their breast cancer so that they can then have smaller operations to remove the cancer. Doctors call this neoadjuvant therapy. Trials are comparing different chemotherapy combinations before surgery to see which work best.
Doctors are also looking at using new types of scans to monitor treatment effects during chemotherapy. They want to see if these scans are better at monitoring breast cancer than the scans we currently use. The scans include
- PET scans
- Infrared scans that process temperature differences in the breast and create a colour coded picture
- 3D ultrasound that takes a detailed ultrasound picture of the breast
- Ultrasound elastography scans that highlight rigid areas of tissue in the breast, which indicates a cancer.
Chemotherapy can damage the ovaries and cause an early menopause in premenopausal women. In the OPTION trial, doctors are giving a hormone therapy called goserelin to women having chemotherapy. Goserelin temporarily stops the ovaries working, and doctors hope this will allow the ovaries to work normally again once the chemotherapy has ended. It is not yet clear how well this may work in preventing early menopause. The trial has closed and we are waiting for the results.
Some trials are looking at combining chemotherapy with biological therapy drugs such as
There is information about trials combining chemotherapy with biological therapy lower down this page.
Triple negative breast cancers don’t have receptors for oestrogen, progesterone or HER2. So hormone treatments and Herceptin do not work well for them. About 15 in 100 breast cancers (15%) are triple negative. To see which drug works best, the TNT trial is comparing docetaxel and carboplatin chemotherapy for women with triple negative breast cancer that has spread to another part of the body. This trial has closed and we are waiting for the results.
Researchers are looking at ways of reducing the side effects of chemotherapy.
People having chemotherapy are more likely to pick up an infection. This is due to a drop in white blood cells called neutrophils (pronounced new-tro-fills). The SPROG trial is looking at giving chemotherapy with a drug called granulocyte colony stimulating factor (G-CSF) that stimulates white blood cell production. It wants to find out if this lowers the number of infections people get during a course of chemotherapy. This trial has closed and we are waiting for the results.
Epirubicin is a chemotherapy drug often used to treat breast cancer, but it can cause damage to the heart. A small study, called BETTER-CARE collected heart scans and blood tests from a number of women having epirubicin to see which of them are affected. Scientists hope they will be able to find a genetic test to identify which patients are more at risk of heart damage. This would mean that these women could be given lower doses than those with a small risk.
Capecitabine is a form of the chemotherapy drug fluorouracil that you take as a tablet. It can be used to treat advanced breast cancer, either on its own or with docetaxel. One of the side effects of this is that the palms of your hands and the soles of your feet may become red, sore, numb or painful (palmar-plantar syndrome). Doctors often prescribe a tablet called pyridoxine (vitamin B6) to help control this. But studies have had mixed results on how well this works.
A small Korean trial found that pyridoxine did not help people taking capecitabine for bowel cancer. But recent results from the UK CAPP-IT trial found that pyridoxine did appear to reduce the rate of hand foot syndrome in people taking capecitabine for advanced breast or bowel cancer.
Early stage breast cancer is usually treated with surgery, and then with radiotherapy to help stop the cancer coming back. The radiation destroys cancer cells that may have been left behind after your operation. If you have radiotherapy to treat your breast cancer you will usually have small doses, from Monday to Friday, for 3 weeks. Or you may have treatment on alternate weekdays for 5 weeks.
Doctors are looking at several different ways of using radiotherapy to treat breast cancer. These include
- Targit, Electron Intraoperative Radiotherapy (ELIOT) and brachytherapy
- Intensity Modulated Radiotherapy
- Changing the doses of radiotherapy
- Radiotherapy to stop HER2 positive breast cancer spreading to the brain
- Radiotherapy for ductal carcinoma insitu (DCIS)
Targit, Electron Intraoperative Radiotherapy (ELIOT), brachytherapy and electronic brachytherapy
Going to the hospital every day during the week can be very tiring, especially if you live a long way away. Doctors are looking at simpler, quicker ways of giving radiotherapy to women with early stage breast cancer including targit, electron intraoperative radiotherapy and brachytherapy. These are all ways of giving radiation inside the breast tissue, instead of aiming it onto the breast from a machine outside the body. The big advantage is that treatment takes much less time than the usual 6 weeks. If successful, these methods could mean speedier treatment for many women with breast cancer and less pressure on radiotherapy equipment and staff. But we need more research before we will know the true benefit.
Targit is a way of giving radiotherapy to women during their breast cancer surgery. It stands for TARGeted Intraoperative radioTherapy. You can find out about it on our page about radiotherapy for breast cancer.
ELIOT stands for electron intraoperative radiotherapy and involves having a single high dose of radiation at the same time as surgery to remove the cancer. After taking out the cancer, the doctor uses a small machine to make and deliver electron radiotherapy beams directly to the area where the cancer was. The machine gives the radiotherapy to your breast for about 25 minutes. The doctor can shape the radiation beam accurately to fit the area that contained the tumour. As there is less normal tissue in the way of the radiotherapy beam, you may have fewer or less severe side effects. It is early days for this treatment and there is not very much research into it in the UK at the moment.
Brachytherapy means giving radiotherapy from the inside of the body (internal radiotherapy). It is not often used to treat breast cancer. But now doctors are testing a new type of brachytherapy after lumpectomy surgery as part of the FORUM trial. They use a new device called MammoSite RTS. After you have had surgery to remove your breast tumour, MammoSite can give radiation doses directly into the tissue in this area. First, your doctor puts a tube like a deflated balloon into the breast tissue. They may do this at the time of your surgery or up to 10 days later. The doctor fills the balloon with salt water (saline) and then threads a tiny wire containing the radiation dose into the balloon. The wire stays in place for a few minutes to give the right amount of radiation and then the doctor removes it. You have this treatment twice a day for about 5 days. The doctor then takes the balloon out. This trial has closed and we are waiting for the results.
Electronic brachytherapy (eBx) is used in some hospitals. Low energy X-rays are given directly into the operation area after removing the breast tumour. The low energy rays do not travel so far into the body tissue. Doctors hope that this will improve the appearance of the breast after surgery compared to standard brachytherapy techniques.
Intensity modulated radiotherapy (IMRT)
Radiotherapy is a standard treatment for breast cancer. But, for some women, it can be difficult to give an even dose of radiotherapy throughout the breast. Women's breasts vary a lot in shape and size. An uneven delivery of radiotherapy to the breast can cause long term side effects, such as scar tissue. This can make the breast shrink. Doctors are trying to find ways to prevent this.
A type of radiotherapy called intensity modulated radiotherapy (IMRT) changes the radiotherapy dose depending on the thickness of the breast tissue. So the whole area treated gets an appropriate dose. Experts say that not everyone needs this type of treatment but that it would help about 1 in 3 women.
Changing the doses of radiotherapy
Radiotherapy causes unwanted side effects. Doctors want to reduce these side effects as much as possible without affecting how well the treatment works. The IMPORT LOW trial is looking at changing the amount of radiotherapy given to women with low risk early stage breast cancer after breast conserving surgery. Some women in this trial had the standard dose of radiotherapy to the area where the cancer was, but others had a lower dose, or none at all, to the rest of the breast. The trial has now closed and we are waiting for the results.
The IMPORT HIGH trial is looking at radiotherapy after breast conserving surgery in women with early stage breast cancer, who have an average or above average risk of the cancer coming back. If you join this trial, you may have a higher than standard dose of radiotherapy to the area where the cancer was. But you have a lower than standard dose to the area of the breast furthest away from the cancer.
The FAST trial is supported by Cancer Research UK. It is looking at giving a large dose of radiotherapy once a week for 5 weeks compared to standard treatment of smaller doses of daily radiotherapy from Monday to Friday for 5 weeks. The trial has found that the side effects of treatment were no worse with the weekly treatment. It is now looking at whether the weekly treatment works as well as the daily treatment at stopping the cancer coming back.
The FAST-Forward trial is comparing 1 week of radiotherapy with 3 weeks of radiotherapy after surgery for breast cancer.
Radiotherapy to stop HER2 positive breast cancer spreading to the brain
If breast cancer spreads, it can sometimes spread to the brain. The HER-PCI trial is looking at giving radiotherapy to the brain, to see how well it stops this happening. It is for women who are due to have Herceptin (trastuzumab) for breast cancer that is locally advanced or has spread to another part of the body. Doctors want to find out how good this treatment is at stopping this type of breast cancer from spreading to the brain. They also want to learn more about the side effects. This trial has closed and we are waiting for the results.
There is a trial comparing different ways of giving radiotherapy to women with ductal carcinoma in situ (DCIS). You usually have about 5 weeks of radiotherapy after surgery for DCIS. This is to help lower the risk of cancer coming back. But doctors are unsure exactly how many radiotherapy treatments are best. This trial is comparing 25 doses (fractions) of radiotherapy to 16 fractions over 3 1/2 weeks. The total amount of radiotherapy women have is the same for both groups. But each individual fraction is higher in the shorter course of treatment. The researchers are also looking into giving a higher dose (a radiotherapy boost) to the area where the DCIS was in the breast.
The researchers hope this trial will find out the best number of radiotherapy treatments to give, if a radiotherapy boost helps to prevent cancer coming back and learn more about the side effects. This trial has now closed and we are waiting for the results.
You can find details of radiotherapy for breast cancer trials on our clinical trials database.
Many women with breast cancer have hormone therapy. Tamoxifen was the first hormone therapy for breast cancer. It can greatly reduce the chance of the breast cancer coming back for some women. Women used to take tamoxifen for only 2 years after they were first treated. Then we found that it is better to take it for 5 years.
In December 2012 the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial reported. It found that for women whose cancer had oestrogen receptors, continuing tamoxifen for 10 years further reduced the risk of the cancer coming back. Taking tamoxifen for 10 years also reduced the number of women who died of their cancer. But it very slightly increased the risk of heart attacks, strokes and womb cancer.
Researchers from the aTTOM trial presented their results at a large conference in 2013. They also found that taking tamoxifen for 10 years rather than 5 years further reduced the risk of breast cancer coming back. One of the possible side effects of tamoxifen is womb cancer. This can be treated successfully if caught early. More women who took tamoxifen for 10 years developed womb cancer compared to the women who stopped taking it after 5 years. The trial team felt that the benefits of taking tamoxifen for longer than 5 years outweighed the risks.
A National Cancer Institute trial in America is looking at whether using tamoxifen as a gel on the breast could be as effective as tamoxifen tablets. Doctors hope that the gel could reduce the risks of side effects such as blood clots and hot flushes. The tamoxifen gel is being tested on women recently diagnosed with DCIS (ductal carcinoma in situ). At the moment though, it's not clear whether this gel can give the benefits of the drug with fewer side effects so we'll have to wait and see what the trial results show. The gel is not available in the UK.
Research has shown that aromatase inhibitors can work well in preventing cancer coming back for some women. These drugs are usually only used for women who have gone through the menopause. Trials have shown that for women with early breast cancer, who have had their menopause, switching to an aromatase inhibitor after 2 or 3 years of tamoxifen reduces the risk of the cancer coming back. It also gives fewer side effects than tamoxifen. Aromatase inhibitors include exemestane (Aromasin), anastrozole (Arimidex) and letrozole (Femara).
Research is testing aromatase inhibitors for women who have not yet had their menopause. As their ovaries are still working, they have treatment to 'switch off' the ovaries and stop them making oestrogen. This is called ovarian function suppression or OFS. Results from the SOFT trial and TEXT trial showed that more pre menopausal women who had treatment with exemestane and OFS were free of breast cancer after 5 years compared to tamoxifen and OFS.
Other trials are looking at giving aromatase inhibitors before surgery to see if they can shrink cancers before surgery and reduce the area that needs to be operated on. One of these trials is the NEO-EXCEL study that is looking at aromatase and COX-2 inhibitors before surgery for early breast cancer in women who have had their menopause. This trial has closed and we are waiting for the results.
This trial is to find the best combination of aromatase and COX-2 inhibitors to shrink postmenopausal breast cancer before surgery.
The IBIS 2 (DCIS) trial is comparing hormone therapies for early, in situ breast cancers (DCIS). Women in this trial take either tamoxifen or anastrozole after surgery to remove DCIS. The aim of the trial is to see if this treatment lowers the risk of the DCIS coming back. This trial has closed and we are waiting for the results.
Some trials are looking at newer hormone therapies such as Trilostane, fulvestrant (Faslodex) and abiraterone. Abiraterone stops the body producing oestrogen and androgens (male sex hormones). It seems that some breast cancer cells have androgen receptors. This is called AR positive breast cancer. Doctors want to see if abiraterone can help women with this type of breast cancer when it has stopped responding to other treatments.
The phase 2 IPET study is looking at a new type of hormone therapy called irosustat for early breast cancer. Women taking part in this study have irosustat during the 2 weeks before they start their planned treatment of chemotherapy before surgery (neo adjuvant chemotherapy). During this time they have 2 PET-CT scans. The researchers will use these scans to find out if irosustat can slow or stop the growth of the cancer. This study has closed and we are waiting for the results. The IRIS study is looking at irosustat in advanced breast cancer. The researchers want to see how well adding irosustat to an aromatase inhibitor works and how safe it is. This study has closed and we are waiting for the results.
Some trials are combining hormone therapy with biological therapies for advanced breast cancer. This includes a new type of biological therapy called palbociclib. The PALOMA 3 trial compared palbociclib and fulvestrant (Faslodex) with fulvestrant and a dummy drug (placebo). The 521 women (both pre and post menopausal) who took part had advanced breast cancer that had continued to grow on hormone therapy. Two thirds of the women had palbociclib and fulvestrant and a third had fulvestrant and placebo.
The researchers found that on average, the women who had palbociclib and fulvestrant lived longer without any signs of their cancer getting worse compared to those who had fulvestrant alone. Doctors call this progression free survival. This was just over 9 months for the women having palbociclib and fulvestrant, and just under 4 months for those having fulvestrant and placebo. The women who had the combination of palbociclib and fulvestrant had more side effects including low blood cell counts, tiredness and sickness. The researchers are still following up the women who took part in this trial, and so it is too early to know if this combination of treatment helps people to live longer overall.
You can find out more about hormone therapy trials for breast cancer on our clinical trials database.
Biological therapies are treatments that act on processes in cancer cells. Many types of biological therapy are being tested for breast cancer. Some therapies are tested alongside standard treatments of chemotherapy, hormone therapy or radiotherapy.
We describe some of the types of trial below but you can find detailed information about biological therapy trials for breast cancer on our clinical trials database.
- Biological therapy before breast surgery
- Biological therapy to prevent breast cancer coming back
- Biological therapy for breast cancer that has come back or spread
- Using biological therapy joined to chemotherapy
Some trials are looking at using biological therapies called monoclonal antibodies, such as Herceptin (trastuzumab) or cancer growth blockers such as lapatinib (Tyverb) to see what effect they have on a breast cancer before surgery.
The ARTemis trial compared the monoclonal antibody bevacizumab (Avastin) and chemotherapy with chemotherapy alone, before surgery for early stage breast cancer. The women who took part had HER2 negative breast cancer that hadn't spread. The trial team found that adding bevacizumab to chemotherapy increased the number of women whose breast cancer completely disappeared. The team are continuing to follow up the women who took part. They want to find out how many women stay free of their cancer and for how long (disease free survival), and how long the women live overall after treatment (overall survival). You can read the results of the ARTemis trial on our clinical trials database.
Some trials are using biological therapies after treatment for early breast cancer to see if they can lower the chance of the cancer coming back. Some of the biological therapy drugs being used in this way include trastuzumab (Herceptin), olaparib and pertuzumab (Perjeta). Some trials are comparing different ways of giving the drugs or giving them for different lengths of time to see which works best. Other trials are combining them with chemotherapy or hormone therapy.
Some trials are looking at whether particular types of biological therapy, such as denosumab (Prolia), can reduce the chance of breast cancer spreading to the bones.
Many trials are looking at using biological therapies to control breast cancer that has come back or spread beyond the breast. The drugs being used in this way include Herceptin (trastuzumab), bevacizumab (Avastin), lapatinib (Tyverb), palbocicib, sunitinib (Sutent), everolimus (Afinitor), olaparib (AZD2281), iniparib (BSI-201), veliparib, temsirolimus, neratinib, pertuzumab (Perjeta), ganetespib, saracatinib, niraparib, lucitanib, ATN-224, BKM120, vaccine therapy, AZD4547, AZD8931, TKI258, and LEE011.
Research is looking into combining monoclonal antibodies with chemotherapy. This type of drug is called a conjugated monoclonal antibody. The monoclonal antibody finds and attaches itself to proteins on the cancer cells and delivers the chemotherapy drug to the cells.
The MARIANNE trial is looking at 2 new drugs called trastuzumab emtansine (T-DM1) and pertuzumab (Perjeta) for breast cancer that has spread to another part of the body or has come back in the same area. The trial is for people who have breast cancer with a large amount of a protein called HER2 on the surface of the cells.
TDM1 is a combination of trastuzumab and a chemotherapy drug called DM1. Trastuzumab finds the cancer cells and delivers the DM1 to them. The researchers want to find out how well TDM1 works on its own and in combination with pertuzumab. The trial has closed and we are waiting for the results.
The THERESA trial is also looking at how well trastuzumab emtansine (T-DM1) works for HER2 positive breast cancer. This trial has closed and we are waiting for the results.
The KATHERINE trial is comparing T-DM1 with trastuzumab for HER2 positive breast cancer.
You can find details of trials using biological therapies for breast cancer on our clinical trials database.
The PRESENT trial is looking at a new vaccine called Neuvax for breast cancer that has receptors for the HER2 protein and has spread to the lymph nodes.
Neuvax combines a man made protein that is similar to the HER2 protein with a drug called granulocyte macrophage colony stimulating factor (GM-CSF). Doctors use GM-CSF to stimulate the body's immune system. The researchers hope that Neuvax will stimulate the immune system to attack any remaining breast cancer cells after finishing standard treatment. Some people will have Neuvax and some will have GM-CSF. The researchers will compare the 2 groups to see how well Neuvax works for breast cancer that has low to moderate amounts of HER2 protein. This trial has now closed and we are waiting for the results.
Bone pain and fractures can be a problem in advanced breast cancer that has spread to the bones. The growth of the cancer starts to destroy bone tissue and weakens the bone in that area.
Drugs being researched that can help to strengthen bones include
Bisphosphonate drugs can help to
- Control bone pain so that you need fewer painkillers
- Slow down the damage caused to bone from bone secondaries, preventing fractures and pressure on the spine
We have detailed information about how bisphosphonates work.
Trials are looking into the most effective bisphosphonates to use in people with advanced breast cancer, and when to use them. Some trials are comparing how well bisphosphonates work compared to other types of treatment, such as radiotherapy, hormone therapy or chemotherapy. Some trials are looking at drugs given by tablet or as drips. Other trials are giving bisphosphonates alongside chemotherapy or hormone therapy.
Bisphosphonates being tested in advanced breast cancer trials include zoledronic acid (Zometa) and ibandronate.
Researchers have also been looking into using bisphosphonates to treat breast cancer at an earlier stage, to see if they help stop the cancer from coming back. The AZURE trial found that adding zoledronic acid to standard treatment doesn't help overall. But it may help some women who have already been through the menopause. You can read the full results of the AZURE trial on our clinical trials database.
Researchers also think that bisphosphonates may help to strengthen bones in women taking aromatase inhibitor drugs as part of their breast cancer treatment. You can find detailed information about trials of bisphosphonates for breast cancer on our clinical trials database.
Denosumab (pronounced den-oh-sue-mab) is a type of monoclonal antibody, which is a biological therapy. Denosumab works by targeting a protein called RANKL on cells that break down bone (osteoclasts). It stops the osteoclasts from breaking down bone. The National Institute for Health and Care Excellence (NICE) recommends denosumab as a possible treatment for preventing complications such as fractures and pain that can happen when breast cancer spreads to bone.
The D-CARE trial is looking at whether denosumab can stop or delay early breast cancer spreading to the bones. It is for women who have early breast cancer and their doctors think there is a high risk of it coming back or spreading to their bones. The trial has closed and we are waiting for the results.
A small proportion of women (3 to 5%) have breast cancer because they have inherited a faulty gene. It is not known if treatment works in the same way for these women as for women who do not have an inherited faulty gene (sporadic breast cancer).
The POSH trial looked at the treatment outcomes for women diagnosed with breast cancer under the age of 40 and for women who had inherited a gene that increases the risk of breast cancer. The researchers found that overall more than 8 out 10 women in the study lived at least 5 years after diagnosis. The women are still being tested to see if they have changes to the BRCA1 or BRCA2 gene. Analysis of these results will show what influence genetic changes have on response to treatment.
A trial is testing a drug called rucaparib (AG-014699) in women with breast cancer who have a faulty BRCA1 or BRCA2 gene and have locally advanced or advanced breast cancer. Rucaparib is a PARP-1 inhibitor which means that it stops the PARP-1 enzyme from repairing damaged cancer cells. The trial has closed and we are waiting for the results.
The 6MP-BRCA trial is testing a combination of the chemotherapy drugs mercaptopurine and methotrexate for advanced breast cancer in people with BRCA gene faults. The trial aims to find out how well a combination of 6MP and methotrexate works in this situation and what the side effects are. This trial has now closed and we are waiting for the results.
Experimental work is looking into removing secondary cancers. This is only suitable for a small number of people. Surgeons most often remove secondary cancers from the liver, although they can sometimes remove them from the lungs. Your doctor can only do this type of surgery if there are just one or two areas of secondary cancer in your liver or lungs. Before they decide to go ahead, they will also consider your general health, how advanced your cancer was when you were diagnosed, and how quickly your cancer came back.
Treating or removing secondary cancer may slow it down or keep it under control for a time. A few different techniques are being tried to remove secondary cancers. They include cryotherapy, radiofrequency ablation and conventional surgery.
Cryotherapy means using a freezing probe to kill and remove tissue.
Radiofrequency ablation uses a heated probe.
The main difference between these techniques and conventional surgery is that your doctor puts the probe through the skin. So you do not need to have a general anaesthetic. Your doctor will give you a sedative to make you drowsy. In the experimental work that has been done, some patients have had treatment several times. It is important to talk things through with your doctor before going ahead. These are not easy treatments to have. You will feel sore and bruised for some days afterwards.
Surgeons have developed a new type of surgery for people with liver tumours in parts of the liver that are usually impossible to treat with surgery. This includes when the tumour is very close to major veins that connect to the liver. This type of surgery is very new and experimental and is used when the patient would die if they did not have the surgery. There is a risk of dying from the surgical operation. The operation involves removing the liver from the body, cutting away the diseased tissue, and then putting back the healthy liver tissue. It is called ex-vivo hepatic resection and reimplantation for liver cancer.
The National Institute for Health and Care Excellence (NICE) has issued guidance to the NHS in England, Wales, Scotland and Northern Ireland about this surgery. They say that there is limited evidence for the safety of this type of operation and it is not clear how well it works but it may be helpful for some people with secondary liver cancer. People having the procedure must receive full information about the possible risks and benefits.
Doctors think that a drug called celecoxib may help to stop some breast cancers coming back after treatment. Celecoxib is a type of drug called a Cox 2 inhibitor. These drugs block a protein called Cox 2 that may help cancers to grow. The REACT trial is looking at whether celecoxib can reduce the chance of an early breast cancer coming back. This trial has closed and we are waiting for the results.
Metformin is a drug doctors usually use to treat diabetes. It works by lowering blood levels of a hormone called insulin. Research has shown that people with breast cancer who have low insulin may do better than those with high levels of insulin. And laboratory studies have shown that metformin may slow the growth of some cancers, including breast cancer.
A trial is looking at metformin for early breast cancer. The researchers want to find out if adding metformin to standard treatment can help people with breast cancer live longer. This trial has closed and we are waiting for the results.
Doctors are looking at ways of finding out if cancer has come back. There is a study looking at symptoms due to cancer coming back after treatment. After treatment for cancer of the breast, lung, prostate or bowel, you have follow up appointments with your specialist doctor. But after a few years, if you stay well, these appointments may stop. You are then asked to see your GP if you have any new symptoms, or are worried about anything.
Researchers looked back at the medical notes of people who went to their GP with symptoms some time after cancer treatment. They looked at people whose cancer had come back as well as people whose symptoms were caused by something else. The trial aims to find common symptoms of cancer recurrence to help doctors spot the signs that cancer may have come back. This trial has closed and we are waiting for the results.
To measure how well cancer treatment is working you usually have a combination of scans and blood tests. Although they work very well in many situations, these scans do not show up changes in the bone so well. So doctors in this study are looking at 3 types of scan that may give clearer information about how the cancer is responding to treatment.
The EBLIS study is looking for substances in blood and tissue samples to help identify breast cancer sooner and to check how well the cancer is responding to treatment.
The DETECT study is a pilot study looking at cancer cells in the bloodstreams of women with breast cancer that has spread to other parts of the body. Small numbers of cancer cells can be found in the bloodstream. They are called circulating tumour cells (CTCs). Doctors want to know more about these cells. They hope this will help them to understand more about how breast cancer spreads, so that they can develop new treatments.
Breast cancer in men is very rare and so there are fewer clinical trials than for more common types of cancer. Much of the information about how to treat breast cancer in men has been learnt from research into breast cancer in women. To try to resolve this a group of experts from all over the world have joined together to develop an International Male Breast Cancer Program. They aim to collect information about men who were diagnosed with breast cancer over the past 20 years and to collect information about those diagnosed now.
The programme will look at the different risk factors, types of tumours, the markers on the tumour, treatment, and how well treatments worked. It aims to gather enough information to do clinical trials specifically for men with breast cancer.
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