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Stage 4 Breast Cancer

Many breast cancer patients begin their treatment or surgery to remove the tumor and adjacent lymph nodes. If these treatments were not successful, then Chemotherapy and HER2 inhibitors are used. In-Addition to the above procedures, external beam radiation therapy, or intensity-modulated radiation therapy can be used. Some breast cancers overexpress receptors for the hormones estrogen and progesterone. These receptors can tell the cancer signal to grow and divide. We are now using various endocrine therapies designed to slow cancer growth. Antiestrogen drugs are treating both premenopausal and postmenopausal women.

CDK 4 and CDK 6 inhibitors to stop cancer cells from reproducing are now the standards of care. We also treat bony metastasis to help keep the osteoclast under control and to strengthen the bones and reduce the risk of fractures. In the United States, unfortunately, breast cancer remains the most frequent cancer in women and the second most frequent cause of cancer death.

Triple-negative breast cancer

New clinical trials available today continue to demonstrate by combining immunotherapy with chemotherapy, and other targeted therapies we can improve survival. This treatment method presented at the breast symposium in Chicago Northwestern University. Where immunotherapy is remarkably different from chemotherapy is in the durability of response. The patient stayed in remission longer. "Chemotherapy, combined with immunotherapy, is the new standard of care treatment for PDL 1 positive triple-negative breast cancer." Some patients do not respond to these therapies, and for this reason, we are incorporating the use of the PARP inhibitors. The MEK is another gene also active in triple-negative breast cancer, and combining these inhibitors with the checkpoint inhibitors shows encouraging results. Other agents are aimed at blocking the AKT pathway. Two different inhibitors used, which are Ipatasertib and Capivasertib. Now with molecular genetic testing, we can find new agents that are effective in these patients. We are finding that combination therapy works best. For these reasons, molecular testing is of critical importance.

Genomic personalize molecular testing

Breast cancer is a heterogeneous disease with many different biologic features. Each feature has a different clinical response to therapy. It is essential to measure various molecular and genomic factors because all patients are different. In addition to defining biologic tumor subsets, currently, gene expression profiling is performed to stratify tumors as having a reasonable risk or bad risk. Several of these are now available commercially. We can now measure genomic "biomarkers," which are pathways that lead to tumor aggressiveness and growth, which can be blocked by both pharmaceutical and natural products.

Chemosensitivity can predict which chemotherapy is most effective. In the landmark study, the MD Anderson Cancer Center was the first to report that a multi Gene analysis of fine-needle aspiration specimens predicts response to different chemotherapies. National organizations such as the Society of clinical oncology, the College of American pathologists, and the National comprehensive cancer network have ongoing efforts to interpret data through these multi Gene biomarkers. Testing for natural substances will show which natural elements can kill your cancer and impede metastasis. Evaluating for chemotherapy resistance is also essential. Also, an evaluation of each patient's immune system is of critical importance.

Prognostic and predictive genomic signatures

Gene expression molecular signatures are currently in clinical use for both defining prognoses for determining the benefits of systemic treatments.

The mama print is a 70 gene signature developed in the Netherlands . He text specific genetic mutations for breast cancer and from this test additional therapies i’ll be incorporated into your breast cancer regimen.

There is now a gene expression profiling analysis to better define the benefits of antiestrogen drugs. The Oncotype DX assay is a predictor of benefits from antiestrogen therapy using multiple real-time reverse transcriptase-polymerase chain reaction. This result is obtained from formalin fixed paraffin embedded tissue. The test is derived from 250 cancer genes selected from published literature, genomic databases, and in-house experiments performed on frozen tissue. From this data, a panel of 16 cancer-related genes and five reference genes used to develop an algorithm to compute a recurrence score ranging from 0-100. The results of this study will be to estimate the odds of recurrence over ten years from the diagnosis.

Estrogen receptor pathway a therapeutic target tested for

Most breast cancer's are intimately linked with exposure to estrogen and alterations in the estrogen receptor signaling pathway. There are regulatory proteins in the premotor region of the estrogen response of genes. These regulatory proteins direct the transcription of numerous growth-promoting genes, including progesterone. The level of estrogen expression is a highly effective predictor for response to antiestrogens recommended for all estrogen expressing tumors. We now know there is a cross-talk relationship in that estrogen can illuminate insulin-like growth factors as well as other growth factors. The use of an aromatase inhibitor is now the standard of care. The problem is that it becomes resistant to this, and in this case, the mTOR and other inhibitors are useful.

Growth factor receptor pathways

These receptor pathways, mainly Tyrosinase kinase receptors, play an essential role in the initiation of cancer. The HER2 is a member of the human epidermal growth factor receptors. The amplification of this gene or protein overexpression is found to 20% of invasive breast cancers and is associated with accelerated cell growth and proliferation and poor outcomes. There are a multitude of other pathways that can now be measured and blocked.

Angiogenesis pathways

Angiogenesis or the formation of new blood vessels around the cancer is a tightly regulated process that has shown to be an essential part of tumor growth and spread. The vascular endothelial growth factor regulates endothelial cell growth and new blood vessel formation. These VEGF cause new blood vessels that feed cancer to grow.

We now know multiple molecular subtypes and clinical presentations exist that are ranging from aggressive to indolent. Recent molecular analysis has shown a light on the heterogenicity by mapping patterns that correspond to clinical phenotypes. We are now able to look at breast cancer susceptibility genes, gene expression, somatic mutations, and epigenetic modifications.

We are now able to measure "liquid biopsies" circulating cancer tumor cells, which are tumor DNA fragments circulating in the blood. These liquid biopsies involve the analysis of circulating tumor cells and help predict metastasis or determine whether cancer cells will return after treatment.

By evaluating the genetic mutations of each cancer, I am now able to personalize all the treatments for the patient. We now know that cancer is a disease of the genome caused by the acquisition of a cell of mutations in specific essential cancer genes. These mutations change pathways involved in regulating cell growth and how the cancer cell interacts with the environment. The Nature publication of February 5, 2020, reported that in the integrative analysis of 2658 whole cancer genomes, there are matching healthy tissues across 38 tumor types.

This analysis is called the Pan-cancer analysis of the entire genomes Consortium. This new molecular testing can promptly evaluate genetic cancer markers that are up-regulated. We can now block these pathways to halt the progression of cancer.

Personalized treatment with targeted therapies

Metronomic chemotherapy is utilized based on the low testing dose. Low-dose chemotherapy does not produce chemoresistance and does not adversely affect the patient's immune system. There are no toxic side effects compared to the conventional method of the maximum tolerated dose chemotherapy due to the use of natural substances, which are synergistic and directly kill cancer cells. New studies show that they decrease chemotherapy resistance and will improve the patient's immune status. All targeted therapies are to block the "biomarkers, "which are driving cancer to grow.

Immunotherapy with checkpoint inhibitors

The use of checkpoint inhibitors along with chemotherapy and radiation are now becoming the standard of care.

Immunotherapy with autologous whole tumor cancer vaccines, dendritic cell therapy and supportive oligonucleotide (SOT)

Personalized vaccines for your stage IV breast cancer are currently treatable. They are created in the laboratory from your cancer cells in your blood. They are injected back into your bloodstream to attack cancer and can be performed several times a year. Optimization of the patient's underlying immune function is of critical importance as with the checkpoint inhibitors and is combined with these checkpoint inhibitors.

Combination therapy
works best

Synergism of these different modalities is the key to success.

Low-dose Metronomic Chemotherapy, Natural Substances, Immunotherapy with Checkpoint Inhibitors, and Immunotherapy with an Autologous whole cancer vaccine, Dendritic cell vaccine, and Supportive Oligonucleotides (SOT) are all combined in a synergistic additive fashion.

If you have stage 4 cancer or triple-negative breast cancer, please call us at 727-330-3844.


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