Un new and extraordinary drug against metastatic breast cancerable to improve and extend patients’ lives. It is no longer just a hope, today it is reality. Even in Italy, from this week, a refund is possible innovative antibody effective for HER2-low type tumors, which until now were treated only with chemotherapy. Here’s what it’s all about.
Metastatic breast cancer, what is the new drug?
Is called Trastuzumab Deruxtecan the conjugated antibody useful in the treatment of breast cancer with low expression of Her2 receptors. But what does it mean? The approval of the Italian Medicines Agency (AIFA), which occurred with publication in Official Journal on December 16, 2023, is definitely a turning point in the treatment of this type of tumor. “As highlighted in the results of the phase 3 DESTINY-Breast04 study and published a year ago on New England Journal of Medicinehas been shown to significantly improve overall and progression-free survival in patients with Her2-low metastatic breast cancer who have previously received chemotherapy,” announces Umberto Veronesi Foundation.
What does “combined antibodies” mean?
“One of the key milestones in breast cancer research was the discovery of hormone receptors on the surface of cancer cells. THE breast carcinomas in fact they can be classified and treated based on the presence or absence of the receptors (HR+ or HR-). Those positive, i.e. HR+, represent approximately 70% of all tumor forms. However, in this group they can be distinguished two subtypes, the Her2+ tumors And Her2-negative. The presence or absence of overexpression of the Her2 receptor is what drives the choice of therapies.
In cases where this alteration is present it is in fact possible to use very effective drugs to selectively target the diseased cells, thus sparing the healthy ones. And this is, for example, the case of conjugated antibodies, drugs composed of an antibody capable of recognizing the Her2 receptor to which they are conjugated chemotherapeutic molecules capable of blocking tumor growth. To date, one of the most cutting-edge drugs in this sense is trastuzumab deruxtecan, also available in Italy from September 2023 in the second-line treatment of Her2+ breast tumors. A drug capable of significantly improving both overall survival and disease-free progression compared to trastuzumab emtansine (T-DM1), one of the most used drugs to date for this type of breast cancer”, explains the Veronesi Foundation.
Smarter chemotherapy
«Trastuzumab deruxtecan allows you to do chemotherapy in a smarter way compared to what we have always done. This is proof that chemotherapy is not necessarily an antiquated methodology. In fact, it can be extremely new if you know how to do it in a more intelligent way”, he declares AdnKronos Giampaolo Bianchini, professor and head of the Breast Group of the Irccs San Raffaele hospital during the press conference ‘Breast cancer: the new frontiers of treatment’, organized in Milan by AstraZeneca and Daiichi Sankyo.
Breast cancer, after 5 years 1 million women look to the future (Getty Images)
HER2-negative breast cancer
On over 55 thousand new breast cancer diagnoses registered in Italy every yearabout 80-85% are classified as HER2-negative. This typology excluded the possibility of using trastuzumab deruxtecan. But now research has found that many Her2-negative tumors still express low levels of the Her2 receptor (hence the concept of Her2-low). And thanks to a team of international experts led by Paolo Tarantino and coordinated by Professor Giuseppe Curigliano, Co-Director of the IEO New Drugs Program, today the Her2 low classification is recognized internationally. From this new classification, in recent years experiments have been started aimed at trying to exploit conjugated antibodies in those women who were previously not considered suitable.
Living with breast cancer, longer and better
In a certain sense, in the indicated cases this new drug can make the disease chronic, allowing patients to gain good quality time. An unexpected goal, so far, which has finally been achieved by Trastuzumab deruxtecan, capable of reducing the risk of disease progression or death by 50%.
«This drug received the green light from Aifa in July 2023 for a certain subtype of breast cancer (HER2 positive), even with brain metastases in patients who have already had a first line of treatment», points out Professor Giampaolo Bianchini. «Now Italian reimbursement is added for another subtype (the so-called HER2 low), for which we only had chemotherapy with which we obtained unsatisfactory results.”
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