Biological therapy for breast cancer
This page is about biological therapies for breast cancer and there is information on
Biological therapy for breast cancer
The most common biological therapy used for breast cancer is Herceptin (trastuzumab).
What Herceptin is
Between 15 and 25 out of every 100 patients with breast cancer (15 - 25%) are likely to respond to treatment with Herceptin. Their cancer cells have a large amount of a protein called HER2 or erbB2. Herceptin blocks signals from the protein that tell these cancer cells to grow. Herceptin also increases the effect of chemotherapy drugs on breast cancer cells.
Who can have Herceptin?
You can have Herceptin for early breast cancer if your cancer cells test positive for HER2, you have completed surgery and chemotherapy (and sometimes radiotherapy), and tests on your heart are satisfactory. You cannot have Herceptin if you have a heart condition that is cause for concern.
Having Herceptin treatment
You have Herceptin through a drip into a vein every 3 weeks for a year. Herceptin can cause heart problems. You will have heart tests throughout your treatment course. If there is any sign that Herceptin is causing heart problems, your doctor may recommend that you stop the treatment.
You can view and print the quick guides for all the pages in the Treating breast cancer section.
Biological therapy is treatment with substances that are made naturally in the body. We can now make some of these artificially and use them in much larger quantities for cancer treatment. Several types of biological therapy are now used to treat breast cancer. They include herceptin, lapatinib and sunitinib.
Herceptin is the most commonly used biological cancer treatment for breast cancer. It is a type of monoclonal antibody which attaches to particular proteins on some breast cancer cells.
Herceptin is also called trastuzumab. Somewhere between 15 and 25 out of every 100 patients with breast cancer (15 to 25%) are likely to respond to treatment with Herceptin. Their cancer cells have a large amount of a protein called HER2Neu or erbB2 and are called HER2 positive. The protein is a growth factor receptor. It transmits signals from outside the cell to the inside, which make the cells grow. The Herceptin antibody attaches itself to this protein receptor and blocks it. Then it can no longer tell the cancer cells to grow. Herceptin also increases the effect of chemotherapy drugs on breast cancer cells.
The National Institute for Health and Clinical Excellence (NICE) have recommended Herceptin as a treatment option for women with HER2 positive early breast cancer after surgery and chemotherapy (and sometimes radiotherapy). You have it through a drip every 3 weeks for a year. The guidance says you should not have Herceptin if you have any of the following heart problems
- Congestive cardiac failure
- Angina that you take medication for
- Uncontrolled high blood pressure
- Evidence of a heart attack on a heart trace (ECG)
- Heart valve disease that is clinically significant
- Certain abnormal heart rhythms, that are uncontrolled
If Herceptin is suitable for you, you have tests on your heart before you start treatment and every 3 months throughout your course of treatment. If there is any sign that Herceptin is causing heart problems, your doctor may recommend that you stop the treatment. You may also stop treatment if your breast cancer comes back at any point during the year of treatment.
Several trials have shown that Herceptin alongside chemotherapy for women with HER2 positive early breast cancer works better than chemotherapy alone. There is more information about trials for Herceptin in early breast cancer in the breast cancer question and answer section of CancerHelp UK.
You can find the NICE guidelines for Herceptin in advanced breast cancer in the secondary breast cancer section of CancerHelp UK.
There is detailed information about the possible side effects of Herceptin in our section on specific cancer drugs.
Lapatinib is a newer drug that was licensed in Europe in June 2008. It is called by the brand name Tykerb in the USA and Tyverb in Europe. It can be used with a chemotherapy drug called capecitabine (Xeloda) for advanced HER2 positive breast cancer if other treatments, including Herceptin, are not working. There are a number of growth factor receptors on the surface of breast cancer cells. When they are triggered, the receptors tell the cell to divide and grow.
Lapatinib blocks the activity of 2 of the receptors - erbB1 (epidermal growth factor receptor 1) and erbB2 (HER2/neu receptor), and so can help to stop the breast cancer cells growing. Lapatinib and capecitabine are both taken as tablets. We will not know if this treatment will be available on the NHS until NICE have assessed it.
Research is still going on into lapatinib for early breast cancer. Doctors also think that lapatinib may work for inflammatory breast cancer. To find out about trials, look in our clinical trials database.
Sunitinib is pronounced sue-nit-i-nib. It is also known by its brand name Sutent (pronounced sue-tent). It is a type of biological therapy called a protein kinase inhibitor. Protein kinase is a type of chemical messenger (an enzyme) that plays a part in the growth of cancer cells. Sunitinib blocks the protein kinase to stop the cancer growing. Trials are looking at
- Sunitinib in combination with capecitabine (Xeloda) chemotherapy for women who have already had chemotherapy for advanced breast cancer
- Sunitinib and docetaxel compared to docetaxel as a first treatment for patients with advanced breast cancer
These trials have closed and we are waiting for the results.
Herceptin has been licensed for 'use in people with early breast cancer'. But the research has only been carried out in women. So NICE don't have the evidence necessary to recommend use of Herceptin in men with early breast cancer. You may still be able to have it but unfortunately it is not clear how well Herceptin will work for you. There is more information about breast cancer in men in this section of CancerHelp UK.
The side effects will vary depending on which drug you have. But the possible side effects of biological therapies for breast cancer include
- Tiredness (fatigue)
- Diarrhoea
- Skin changes (rashes or discolouration) - rashes may be severe for some people
- A sore mouth
- Weakness
- Loss of appetite
- Low blood counts
- Swelling of parts of the body, due to build up of fluid
Tell your doctor if you have any of these as you can have medicines to help to control them. There is information about the side effects of individual biological therapies in our biological therapy section.
Look at the main biological therapy section in CancerHelp UK for detailed information. You can ask your doctor or specialist nurse to write down the names of the drugs you will have so you can look them up in our specific drug side effects section. There are pages there for all the most commonly used biological therapy drugs. Each page has information about common, occasional and rare side effects for that drug.
Scientists and doctors are working together all the time to investigate new biological therapy drugs and combinations. You can find out about current trials for breast cancer by searching our clinical trials database. Choose 'breast' from the drop down menu of cancer types.
You may also like to contact one of the breast cancer organisations. They often have books and leaflets, some of which are free. We also have details of breast cancer books.
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