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Oncology Overview

 

GENERAL THOUGHTS REGARDING SYSTEMIC TREATMENT FOR BREAST CANCER

Raoul Mena, MD
Dept. of Oncology
Saint Joseph Medical Center
Burbank, CA 91505

The general treatment for breast cancer incorporates treatments that are effective locally, such as surgery to remove a lump or radiation treatment given to the breast itself and arm pit, as well as to localized areas in the body to treat more established disease. Chemotherapy and other biologic agents are used primarily to treat either established or occult breast cancers that may have traveled to other parts of the body. The successful treatment for breast carcinoma usually employs all three modalities.

The goal of systemic treatment of cancer is to kill established breast cancer cells that either may be obvious by physical exam, blood studies or imaging studies, as well as to treat potentially occult disease that is not obvious on physical or radiographic examination.

The use of chemotherapy and/or hormonal agents systemically will allow us to treat and hopefully eradicate either occult metastatic disease, when it is used in the adjuvant format, or to treat established obvious disease some place in the body. These treatment modalities tend to travel throughout the entire body and not only do they have beneficial effects in treating the cancer, but they also may cause undesirable side effects. The treatment guidelines noted in our website incorporate the latest treatments using chemotherapy, hormonal therapies and/or a combination of both, as they are available and published in 1997.

It is with great expectation, however, that we are awaiting newer treatment modalities in the systemic treatment of breast carcinoma. One of the newer modalities includes the use of a monoclonal antibody. This monoclonal antibody is hoped to be specific for some of the cancer cells, thus limiting the systemic side effects associated with chemotherapy or hormonal therapy. The antibodies could be directly toxic to the cancer cells, or they may be attached to some other compound such as a radioactive drug or a toxin and will hopefully be more specific in killing cancer cells. These monoclonal antibodies are currently under intense study and hopefully will be available in the near future. Cancer cells need to divide and grow to produce their effects. Newer treatment choices will be included in future medications that will directly induce the cell to die in a process known as apoptosis. One of the problems with cancer cells is that as they grow and divide, they tend to accumulate and they do not complete their life cycle by dying. These drugs will hopefully induce the cells to mature and become inactive. Another treatment modality under current investigation is the development of so-called antiangiogenic factors. All cells in the body must receive oxygen and nutrients to grow. By interfering with the growth of blood vessels into tumor masses, may limit the size of tumors so that they do not cause damage.

The monoclonal treatments, the drugs that will induce apoptosis and drugs that will inhibit the growth of blood vessels (antiangiogenic factors) should five us enhanced treatment modalities that also minimize the side effects. As these compounds become available for general usage, they will be incorporated into our treatment guidelines.


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