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Treatment for early breast cancer - research and clinical trials

Find out about research and clinical trials looking at treatment for early breast cancer.

Early breast cancer means the cancer has not spread beyond the breast or the lymph nodes in the armpit on the same side of the body. Research is looking at improving the treatment of early breast cancer. And ways that will improve quality of life during and after treatment.

Surgery

Doctors usually remove early breast cancer with surgery. Researchers are looking at new ways to improve surgery. 

New devices to help surgeons remove the cancer

Surgeons are looking at ways to improve breast conserving surgery. For this type of surgery they only remove the cancer and a border (margin) of surrounding tissue.

Some women need further surgery if the margin is not clear of cancer. To avoid this, surgeons are researching new devices to use in surgery. The devices check whether they have removed all the breast cancer. They include the MarginProbe, Intelligent Knife and magnetic markers. 

Breast reconstruction

Your surgeon can reconstruct your breast if your surgeon needs to remove your breast (mastectomy). It is called immediate reconstruction if you have this at the same time as your mastectomy. Researchers are using a sheet of tissue to provide extra cover and support to the implant. They want to know if this improves the outcome of immediate breast reconstruction.

Treatment of the lymph nodes in your armpit

Doctors are still unclear about the best way to treat the lymph nodes in your armpit. Researchers have compared radiotherapy to the armpit with surgery to remove the lymph nodes. They found for some women radiotherapy was as good as surgery in preventing cancer from coming back in the lymph nodes. The researchers in this study didn't include women who had chemotehrapy before surgery and still had cancer cells in their lymph nodes. 

Researchers are now comparing women who have treatment to the lymph nodes in their armpit with women who don’t. They want to find out if treatment to the armpit is necessary.

Chemotherapy

We know from research that most breast cancers respond well to chemotherapy, but unfortunately some don’t. If doctors could tell whether chemotherapy was working at an earlier stage, some people could avoid having treatment that wouldn't help them.

Doctors are looking at new types of scans and blood tests to monitor how well chemotherapy is working. Researchers are looking at:

  • PET scans to show up cancer cell death after chemotherapy
  • MRI scans, to see how well chemotherapy is working
  • samples of your cancer and blood tests to find out which cancers respond to chemotherapy and to check how well chemotherapy is working

Researchers are also looking at chemotherapy side effects. There are studies looking at:

  • protecting the ovaries to prevent early menopause
  • reducing side effects such as heart problems or infections
  • predicting who might have side effects
  • coping with side effects

uPA test

The uPA test is a new test. It stands for urokinase Plasminogen Activator, which is a protein that's a natural part of the healing process. Researchers hope it might help predict who needs chemotherapy in people with newly diagnosed breast cancer. They're also looking at it as a possible test for other types of cancer. 

Radiotherapy

Doctors often treat early stage breast cancer with surgery followed by daily radiotherapy to help stop the cancer from coming back. Researchers are looking at simpler, quicker ways to give radiotherapy. This includes research into:

  • giving radiotherapy to women during their breast cancer surgery
  • changing the dose and timing of radiotherapy
  • whether women at very low risk need radiotherapy

Research is also looking at a type of radiotherapy called intensity modulated radiotherapy (IMRT). This type changes the radiotherapy dose, depending on the thickness of breast tissue. It means doctors can give higher dose of radiotherapy to the area of the breast where the cancer was. And give a lower dose to the rest of the breast. Doctors hope this can reduce the risk of side effects. The trial is now closed and we're waiting for the results. 

Hormone therapy

Many women with early breast cancer take hormone therapy to lower the risk of the cancer coming back.

Researchers have looked at:

  • how long women should take hormone therapy for
  • the timing of treatment
  • comparing how well different hormone therapies work
  • taking hormone therapy before surgery
  • taking hormone therapy with biological therapy

There are several types of hormone therapy which work in different ways. Aromatase inhibitors are a type used for postmenopausal women. Research has found that these drugs can help premenopausal women, if they take them alongside treatment to switch off their ovaries.

Doctors are looking at new hormone therapy drugs for early breast cancer including:

  • enzalutamide
  • irosustat

Targeted drugs and immunotherapy

Targeted drugs change the way that cells work e.g. they can block signals that tell cells to grow. Immunotherapies can boost the body’s own immune system to fight off or kill cancer cells.

The most commonly used targeted drug for early breast cancer is trastuzumab.

In early breast cancer, researchers are looking at targeted drugs:

  • before surgery or chemotherapy, to see what effect they have on breast cancer
  • after surgery, to prevent breast cancer coming back or spreading
  • in combination with other treatments such as hormone therapy or chemotherapy, to prevent breast cancer coming back

There are many types of targeted drugs and immunotherapies. For early breast cancer, researchers are looking at:

  • monoclonal antibodies, such as trastuzumab (Herceptin), pertuzumab , denozumab or ABP 980
  • cancer growth blockers, such as lapatinib, everolimus or AZD5363
  • parp-1 inhibitors, such as olaparib or rucaparib
  • vaccines, such as Neuvax
  • targeted drugs joined to chemotherapy, such as TDM1

Some clinical trials are looking at how well these drugs work for particular types of breast cancer. This includes triple negative breast cancer, or people with inherited breast cancer.

Gene tests to decide on treatment

We know that two people with breast cancer may have differences in their cancer cells. The differences mean that the cancers will respond to different types of treatment. If your cancer doesn’t have a particular cell change, the medicine that targets that change won’t work.

Clinical trials are looking at the genetic makeup of breast cancer cells before or during treatment. Researchers want to know if particular genes affect how well treatment works. And they want to know whether genetic testing can help doctors decide who should have particular types of treatment after surgery.

Other drugs to stop breast cancer coming back

Doctors are researching drugs that might lower the risk of breast cancer coming back or help women live longer. Researchers are looking at:

  • celecoxib, which is a type of drug called a cox 2 inhibitor
  • aspirin
  • metformin, which is a type of drug used to treat diabetes
  • rivaroxaban, a drug that thins the blood , researchers want to find out if it works as an anti cancer drug and if it can stop cancer spreading

Research into different types of early breast cancer

Triple negative breast cancer

Triple negative breast cancers don’t have receptors for oestrogen, progesterone or Her2. Treatments such as hormone therapy or Herceptin don’t work. Doctors are looking at ways to improve treatment.

For triple negative early breast cancer, researchers are looking at:

  • a hormone drug called enzulatamide for breast cancer with androgen receptors – androgens are hormones made in both men and women, and some triple negative breast cancers have androgen receptors
  • biological therapies to prevent breast cancer coming back, such as olaparib and rucaparib

Ductal carcinoma insitu (DCIS)

Ductal carcinoma in situ (DCIS) means that cells inside some of the ducts of your breast have started to turn into cancer cells. These cells are all inside the ducts and have not started to spread into the surrounding breast tissue.

Doctors are not sure that low risk DCIS would ever become invasive cancer. So researchers are comparing surgery with monitoring by having yearly mammograms. This is for women with low risk DCIS.

Researchers are also looking at:

  • different hormone drugs, to find out which is best at stopping DCIS from coming back after surgery
  • internal radiotherapy (brachytherapy) compared to external radiotherapy
  • genetic changes that increase the risk of developing DCIS

Breast cancer in men

Breast cancer in men is very rare and so there are fewer clinical trials than for more common types of cancer.

Experts from all over the world have developed an International Male Breast Cancer Program. They are collecting information about men diagnosed with breast cancer both in the past and now. 

They will look at the different risk factors, tumour types, 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.

Inherited breast cancer

A small number of women have breast cancer because they inherited a faulty gene. Doctors do not know if treatment works in the same way for these women as for women who do not have an inherited faulty gene.

Trials are looking at a biological therapy called rucaparib in women with breast cancer who have a faulty BRCA1 or BRCA2 gene. This drug is a type of biological therapy called a PARP-1 inhibitor. This means it stops the PARP-1 enzyme from repairing damaged cancer cells.

Side effects

Researchers are looking into better ways of people reporting side effects. They want to find out if reporting them on line works better than reporting them in the usual way. 

Researchers are also looking into whether acupuncture can help with nerve damage from treatment making doing fiddly things diffcult to do.

There is also research looking into whether art therapy can help people cope with pain after treatment for breast cancer.

Treatment for breast cacner can put women unto a menopause. Coping with the symptoms can be difficult. Researchers are investigating whether cognitive behavioural therapy can help control hot flushes and night sweats.  

Information and help