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Biological therapy for breast cancer

Biological therapy is treatment that changes the way cancer cells interact and stops them sending signals that make them divide and grow. Herceptin (trastuzumab) is the most common biological therapy used for breast cancer.

What Herceptin is

Between 20 and 25 out of every 100 patients with early breast cancer (20 to 25%) are likely to respond to treatment with Herceptin. Their cancer cells have large amounts of a protein called HER2 or erbB2. Herceptin blocks signals from the protein that tell these cancer cells to grow. Herceptin also increases the effect of chemotherapy drugs on breast cancer cells.

Other biological therapies for breast cancer

Lapatinib (Tyverb) is sometimes used with a drug called capecitabine (Xeloda) for advanced breast cancers that have receptors for lapatinib on their cells. Doctors are also researching it for early breast cancer and inflammatory breast cancer. Researchers are looking at sunitinib (Sutent) and everolimus (Afinitor) in trials to see if giving them with chemotherapy gives better results than chemotherapy on its own.
 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating breast cancer section.

 

 

Types of biological therapy for breast cancer

Biological therapy is treatment with drugs that change the way cancer cells interact and stops cancer cells sending signals that make them divide and grow. Several types of biological therapy are now used to treat breast cancer. They include trastuzumab (Herceptin) and lapatinib (Tyverb). Other types of biological therapy are being used in clinical trials, such as everolimus (Afinitor) and sunitinib (Sutent).

 

Herceptin (trastuzumab)

Herceptin (trastuzumab) is the most commonly used biological therapy for breast cancer. It is a type of monoclonal antibody that attaches to a particular type of protein. Some breast cancer cells have a lot of this protein and are called HER2 positive. The protein is a growth factor receptor. It transmits signals from outside the cell to the inside, which make the cells grow. Herceptin attaches itself to this protein receptors and blocks them. Then they can no longer tell the cancer cells to grow. Herceptin also increases the effect of chemotherapy drugs on breast cancer cells.

Somewhere between 20 and 25 out of every 100 patients with breast cancer (20 to 25%) are HER2 positive and likely to respond to treatment with Herceptin. 

When you are diagnosed with breast cancer, doctors use a test called immunohistochemistry (IHC) to test the level of the HER2 protein in the tumour sample. The test grades your HER2 level between 0 and 3+. 

If the level is 0 to 1 you have low levels of HER2 and won't benefit from Herceptin.

If the level is 2+, your doctors will do a more accurate test called fluorescence in situ hybridisation (FISH testing). This test looks for a gene called HER2/neu that makes the cell produce the HER2 protein. If the amount of the gene is high (called gene amplification) you will benefit from Herceptin treatment.

If the level is 3+, you have high levels of HER2 and will benefit from Herceptin 

The National Institute for Health and Care Excellence (NICE) has recommended Herceptin as a treatment option for women with HER2 positive early breast cancer after surgery and chemotherapy (and radiotherapy if needed). You have Herceptin every 3 weeks for a year. The guidance says you should not have Herceptin if you have any of the following heart problems

  • Congestive cardiac failure
  • Angina that you take medicines for
  • Uncontrolled high blood pressure
  • Evidence of a heart attack on a heart trace (ECG)
  • Heart valve disease that is causing physical effects
  • Certain abnormal heart rhythms, that are uncontrolled

If Herceptin is suitable for you, you have tests on your heart before you start treatment and every 3 months throughout your course of treatment. If there is any sign that Herceptin is causing heart problems, your doctor may recommend that you stop the treatment. You may also stop treatment if your breast cancer comes back at any point during the year of treatment.

Several trials have shown that Herceptin alongside chemotherapy for women with HER2 positive early breast cancer works better than chemotherapy alone. There is information about trials for Herceptin in early breast cancer in the breast cancer question and answer section.

You can find details of the NICE guidelines for Herceptin in advanced breast cancer in the secondary breast cancer section.

There is detailed information about the possible side effects of Herceptin in our section about specific cancer drugs.

 

Lapatinib (Tyverb)

Lapatinib stops breast cancer cells growing by blocking particular growth factor receptors on their surface. It can be used with a chemotherapy drug called capecitabine (Xeloda) for secondary or locally advanced HER2 positive breast cancer if other treatments, including Herceptin, are not working. Lapatinib and capecitabine are both taken as tablets so you can usually have this treatment at home after the first dose.

Lapatinib is sometimes used in combination with hormone therapy drugs called aromatase inhibitors in women who have hormone receptor positive and HER2 positive breast cancer.

Some trials have looked at giving Herceptin with lapatinib for advanced breast cancer. At the moment Herceptin is not licensed to be given in combination with lapatinib. 

Research is going on into new ways of using lapatinib for early breast cancer. Doctors also think that lapatinib may work for inflammatory breast cancer. To find out about trials, look at our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown list of cancer types and 'biological therapy' from the dropdown list of treatment types.

 

Other biological therapies

Other biological therapies being researched in breast cancer trials include Sunitinib (Sutent) and everolimus (Afinitor)

Sunitinib is pronounced sue-nit-i-nib. It is also known by its brand name Sutent (pronounced sue-tent). It is a type of biological therapy called a protein kinase inhibitor. Protein kinases are a type of chemical messenger (an enzyme) that plays a part in the growth of cancer cells. Sunitinib blocks the protein kinase to stop the cancer growing. Trials are looking at sunitinib for advanced breast cancer. The trials are looking at sunitinib in combination with chemotherapy drugs. 

Everolimus is pronounced ever-oh-lih-mus. It is also known by its brand name Afinitor. It is a type of cancer growth blocker called an mtor inhibitor. It stops some cancer cells from dividing and growing. The National Institute for Health and Care Excellence (NICE) has looked at whether it should be available for women whose breast cancer is advanced, HER2 negative and cancer has grown with other treatments in combination with the hormone therapy exemestane. NICE does not recommend it as it says that it is not cost effective. 

Trials in the UK are looking at using everolimus with chemotherapy, hormone therapy or other types of biological therapy, for HER2 positive breast cancer that has spread outside the breast. 

You can find details of these trials on our clinical trials database.

 

Men with breast cancer

Herceptin (trastuzumab) has been licensed for use in people with early breast cancer. But the research has only been carried out in women. So NICE don't have the evidence necessary to recommend the use of Herceptin in men with early breast cancer. You may still be able to have it but unfortunately it is not clear how well it will work. 

There is detailed information about breast cancer in men in this section. Because breast cancer in men is very rare it is also difficult to know how well other types of biological therapy will work.

 

Side effects of biological therapies

The side effects vary depending on which biological therapy drug you have. But the possible side effects of biological therapies for breast cancer include

Tell your doctor or chemotherapy nurse if you have any of these effects as you can have medicines to help to control them. There is information about the side effects of individual biological therapies in our cancer drugs section.

 

More information about biological therapies

Look at the main biological therapy section for detailed information. You can ask your doctor or specialist nurse to write down the names of your drugs so that you can look them up in our drug side effects section. There are pages for all the most commonly used biological therapy drugs. Each page has information about the common, occasional and rare side effects for that drug.

Scientists and doctors are working together all the time to investigate new biological therapy drugs and combinations. You can find out about current trials for breast cancer by searching our clinical trials database. Choose 'breast' from the dropdown menu of cancer types.

You may also like to contact one of the breast cancer organisations. They often have books and leaflets, some of which are free. We also have details of breast cancer books and leaflets.

You can also contact our cancer information nurses. They would be happy to help.

If you want to find people to share experiences with online, you could use CancerChat, our online forum.

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Updated: 24 October 2012