Published Wed, 2010-09-29 14:07; updated 34 weeks ago.
A quick guide to what's on this page
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. And so we 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.
For breast cancer, researchers are looking into surgery, including new ways of checking lymph nodes and removing secondary cancers, radiotherapy, chemotherapy, hormone therapy, biological therapies, and 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.
Why we need research
It is usual now to have a sentinel node biopsy at the same time as having your breast cancer removed. This means that the surgeon removes the lymph node most likely to contain cancer cells from the tumour. If cancer cells are found in the sentinel node, they may also have spread further in the body. You will need to have more treatment to the lymph nodes in your armpit. The Amaros trial is trying to find out whether radiotherapy to this area, or surgery to remove these lymph nodes, is the best way to stop the cancer coming back in this area, and how the side effects compare. The trial is now closed and we are waiting for the results.
Some research is also 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 insert tiny tubes and special instruments. Liposuction removes any excess fat in the area and the surgeon then removes some lymph nodes. NICE recommends that currently this procedure is only used in research trials.
Tests to decide on treatment after surgery
Usually doctors do tests to check the stage and grade of a cancer to decide who should have more treatment after surgery. 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.
If you are in this trial, you will have standard tests and genomic tests. If the tests suggest that you are at a high risk of the cancer coming back, you will have chemotherapy. If both tests suggest you are at low risk, you will not have chemotherapy. If one test suggests that you should have chemotherapy, but the other does not, you will be put at random into one of two groups, and you may or may not have chemotherapy. Different chemotherapy combinations are being used as part of the trial. Your cancer cells will also be tested to see in they are hormone receptor positive. If the cancer cells have hormone receptors, you will have hormone therapy.
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. Go to the advanced search and choose 'breast' from the dropdown list of cancer types, then choose chemotherapy from the type of treatment list. For details of closed trials, tick the box for trials that have finished recruiting.
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
New chemotherapy drugs and combinations
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
- Gemcitabine and paclitaxel (GemTaxol)
- Liposomal doxorubicin
- Eribulin myeslate (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.
Monitoring effects of treatment
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 an area of cancer.
Protecting the ovaries during treatment
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.
Using chemotherapy with biological therapy drugs
Some trials are looking at combining chemotherapy with biological therapy drugs such as bevacizumab (Avastin) (a monoclonal antibody), everolimus (Afinitor), gene therapy, and sunitinib (Sutent). There is information about trials combining chemotherapy with biological therapy lower down this page.
Chemotherapy for triple negative cancers
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. 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, to see which works best.
Chemotherapy side effects
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 has looked at giving chemotherapy with a drug that stimulates white blood cell production called G-CSF to see if this lowers the number of infections people get during a course of chemo. This trial is no longer recruiting patients 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 has 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. The trial has closed and we are waiting for the results.
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. However, there isn't much evidence to show how well pyridoxine works. A trial called CAPP-IT has been trying to find out the best dose of pyridoxine for breast cancer patients taking capecitabine. This trial is no longer recruiting patients, and we are waiting for the results.
All these trials are on our clinical trials database.
- Targit, Electron Intraoperative Radiotherapy (ELIOT) and brachytherapy
- Intensity Modulated Radiotherapy
- Radiotherapy after surgery for breast cancer for older women
- Changing the doses of radiotherapy
- Radiotherapy to stop HER2 positive breast cancer spreading to the brain
IMPORT HIGH 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 a lower than standard dose to the area of the breast furthest away from the cancer. We have information about the IMPORT trials in our breast cancer question and answer section.
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, and learn more about the side effects. This trial is now closed and we are waiting for the results.
You can find details of radiotherapy for breast cancer trials on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'radiotherapy' from the list of treatments.
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. Now we know that it is better to take it for 5 years. Doctors are now researching whether it is even better to take it for up to 10 years after surgery for early breast cancer. We need to test this because taking the drug for longer won’t necessarily lower the risk of breast cancer coming back and could increase the side effects. Doctors are also concerned that taking the drug for longer could increase the risk of side effects.
Research has shown that aromatase inhibitors are effective 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 and 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. Some trials are comparing aromatase inhibitors to other treatments, including stopping the ovaries from working (ovarian ablation), celecoxib and triptorelin. 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.
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.
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.
Some trials are combining hormone therapy with biological therapies for advanced breast cancer.
You can find out more about hormone therapy trials for breast cancer on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'hormone therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.
Biological therapies are treatments with substances that are made naturally by the body or that affect normal body processes. 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. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.
- Biological therapy before breast surgery
- Biological therapy to prevent breast cancer coming back
- Biological therapy for breast cancer that has spread
Biological therapy before breast surgery
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 is looking at giving the monoclonal antibody bevacizumab (Avastin) with chemotherapy before surgery.
Biological therapy to prevent breast cancer coming back
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) and lapatinib (Tyverb). 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. There is information about Herceptin trials for early stage breast cancer in the breast cancer question and answer section.
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.
Biological therapy for breast cancer that has spread
Many trials are looking at using biological therapies to control breast cancer that has spread beyond the breast or to other parts of the body. The drugs being used in this way include Herceptin (trastuzumab), bevacizumab (Avastin), lapatinib (Tyverb), sunitinib (Sutent), denosumab (Prolia), everolimus (Afinitor), olaparib (AZD2281), iniparib (BSI-201), panobinostat (LBH589), temsirolimus, neratinib, pertuzumab, ATN-224, vaccine therapy and TKI258.
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. 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
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 are also looking into using bisphosphonates to treat breast cancer at an earlier stage. Giving bisphosphonates to women who have stage 2 or 3 breast cancer may help prevent the cancer from coming back after surgery or radiotherapy. The D-CARE trial is trying to find out if a bisphosphonate called denosumab can stop or delay breast cancer spreading to the bones.
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. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'bisphosphonates' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial 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). So a trial has been comparing the treatment effects and outcomes in 2 groups of women with breast cancer. One group has an inherited faulty gene (hereditary breast cancer). Women in the other group do not have the faulty gene. The trial is called the POSH trial and aims to find out whether women younger than 41 with hereditary breast cancer need to have different treatment from other women with breast cancer. This trial is no longer recruiting patients and we are waiting for the results.
There is a trial testing a drug called AG-014699 in women with breast cancer who have a faulty BRCA1 or BRCA2 gene. You may be able to enter this trial if you have locally advanced or advanced breast cancer. AG-014699 is a PARP-1 inhibitor which means that it stops the PARP-1 enzyme from repairing damaged cancer cells.
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.
A few different techniques are being tried to remove secondary cancers
Treating or removing secondary cancer may slow it down or keep it under control for a time.
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 – for example, 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 Clinical 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.
A study is looking at symptoms which could be caused by 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. The trial has now closed. You can find details on our clinical trials database. Choose 'breast' from the dropdown menu of cancer types to find breast cancer trials.
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. You can find out about this trial on our clinical trials database – type detect into the text box.