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The Latest Medical Oncology Treatments for Breast Cancer
Dr. Arindam Bagchi, a Medical Oncologist at Regional One Health, discusses the latest medical oncology treatments for breast cancer and how they are improving patient outcomes and quality of life.
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Learn more about Arindam Bagchi, MD
Arindam Bagchi, MD
Arindam Bagchi, MD is a medical oncologist at Regional One Health. He treats cancer diagnoses using medical treatments such as chemotherapy, immunotherapy and targeted therapy.Learn more about Arindam Bagchi, MD
Transcription:
Alyne Ellis (Host): One on One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. I'm Alyne Ellis and our subject today is treatment options for breast cancer. Joining me is Medical Oncologist, Dr. Arindam Bagchi. Welcome and thank you doctor for clarifying such an important issue.
Arindam Bagchi, MD (Guest): Thank you. Pleasure is all mine.
Host: Let's begin with, how do you determine which medical oncology therapies are best to treat a patient's specific breast cancer diagnosis?
Dr. Bagchi: First of all, I'd like to give a brief introduction by saying all breast cancers are not one. Breast cancers can be broadly of three types; hormone positive, HER2 positive or triple negative. These are markers which are tested when the breast cancer is diagnosed and studied under the microscope after the patients get a tissue biopsy. That is where either a needle is taken in and biopsied.
And after that we come to these results. So, the treatments vary widely based on what type of breast cancer it is. nOw coming into the details of the treatments, before starting treatments, we determine what the patient wants. If the patient wants surgery first, if that is an option for early breast cancer, that's always done first. And then after that depending on what risks are there for the patients, we either do hormone therapy for hormone positive breast cancers, or chemotherapy, along with other biological therapies for HER2 positive breast cancers and chemo, and sometimes chemo immunotherapy for triple negative breast cancer. So all in all, it varies widely depending on what exact subtype of breast cancer a patient may have.
Host: So, looking across these three categories, you've delineated, what are some of the latest medical oncology treatment options that you offer for breast cancer patients?
Dr. Bagchi: It's very important to understand medical oncology means medical treatments. A medical oncologist would offer either pills or chemo or immunotherapy, or biological therapy, which most of them are IV treatments to patients. Going one by one. Earlier we used to use chemotherapy for almost all breast cancers if we had to treat them from the medical standpoint. Nowadays for hormone positive breast cancers, some of the recent advancements actually do not warrant the patient to get chemotherapy for hormone positive breast cancers.
And what we do is basically give them pills, targeted therapy and pills and anti hormonal pills. So that's one of the great advancements that we have had over the last few years. Moving on to triple negative breast cancer, which of the three types is more aggressive and associated with worse features. Nowadays, we have chemotherapy with immunotherapy, which was recently approved by the FDA for triple negative breast cancers, which tend to do better than just chemotherapy and for the other subtype, which is HER2 positive breast cancer; we now have biological treatments, antibody treatments, along with chemotherapy which tend to offer better results for patients than just chemotherapy or just doing biological therapy.
Host: So, with all these new advances, what can patients expect in terms of what happens during treatment and the resulting side effects and how long the treatment will last? I'm sure, in each category there's an awful lot to detail.
Dr. Bagchi: This is just a very brief overview. But the way we practice breast medical oncology nowadays is very patient specific. It's personalized to each patient's unique cancer, their health, their stage of the cancer more importantly, and the treatment duration depends on what stage of the cancer they have. For example, a patient with very early, HER2 positive breast cancer, will have potentially one year of treatment. And after that, if they do not show any signs of cancer left, then they can just be followed up with frequent scans and frequent office visits. This would be different for another patient in a different situation.
For example, if they have widespread cancer say triple negative or HER2 positive cancer, then in that case, the treatment durations tend to be much prolonged up until either the cancer is shrinking down or up until the patient is able to tolerate going from months to maybe years and subsequent lines of treatments, other treatments, if one doesn't work and it keeps going on in that stage. For hormone positive breast cancers that we say, if they're early and they can be taken out by surgery; generally we look at five years of treatment, post surgery, but again, this can go higher up to 10 years. And the treatment we are talking about here in hormone positive cases are pills. We take anti-hormone pills. We prescribed them to the patients depending on their profile and features of the cancer, again and take it from that up to five or up to 10 years, again, depending on how the patient can tolerate them.
Host: So, with these new treatments, are we also getting better and have more knowledge about how to handle the side effects?
Dr. Bagchi: Definitely. With chemotherapy the old days, everybody was scared and horrified, okay. We'll have chemotherapy. We'll be sick, deathly. But nowadays, that's not the case. Nowadays chemotherapy is much more tolerable. For example, if you say that for patients who are getting back for their treatments of breast cancer, because we have had so many new medicines and more effective medicines, which can, for example, prevent and treat nausea patients. Nowadays, if they get nausea, then at least something is not given right in that situation because we have such greatly effective anti-nausea medicines. Also we have medicines which can treat side effects, such as nerve side effects. Medicines, which can treat other side effects with hormone therapy, such as hot flashes. We have effective medicines, which treat that. Sometimes patients get bone problems and we have medicines which can prevent their bones from becoming thin or worse and prevent fractures. So all these have together led to supportive care, which has improved a lot over the last few years in patients who are getting medical treatments for their breast cancer.
Host: Now, I know you can't necessarily speak in specifics, particularly when somebody comes to you and is really an advanced stage, but in general, what types of outcomes are you now seeing as a result of these treatments that with the new measures that you're putting in place?
Dr. Bagchi: Yeah. So this, this is again, a very evolving, moving target and the numbers continue to improve, I would say over the last five to eight years. Again, this is very dependent on what is the stage of the patient's cancer that the patient is initially found with. Again, a stage one or stage two hormone positive breast cancer, more than likely, fair better, and will have slightly longer, you know, survival and a great chance for getting cured of the cancer as compared to somebody who comes in with a much advanced stage of the cancer and an aggressive cancer. The numbers would be very specific to stage in which they present.
But overall, if you talk about advanced stage, it has improved a lot. For example, if hormone positive breast cancer, there is an advanced stage patient coming up again, these are averages, different patients can fall in different timeframes of these averages, generally with the first line oral treatments, the average lifespan is about two years. Again, taking it as an average. And after that also we have much more treatments if they do not do well on the first treatment, we can always go to the second of the hormone and targeted treatments. Just as a small example, the numbers are improving.
Again, if we take the last 10 years versus the last four years, the numbers would be on a constant rise and patients are living longer with advanced disease with advanced breast cancers of all the three subtypes over the board.
Host: Could most of the cancers that you see be found with early detection through mammography?
Dr. Bagchi: Yes. Most of the cancers that we do see are early breast cancers, to be honest. Only one third of the patients, roughly 30 to 40% of the patients tend to present as advanced cancers or even the advanced cancer that we do end up seeing are coming from cancers have were known to us many years ago and they just came back.
Mammography is one of the very important tools and it helps us detect breast cancer very early, in early stage so that we can cure it. And that's the importance of screening for breast cancer by mammography. Screening means cancer is found before it causes any symptoms or before it's big enough to cause any trouble. So we find that on screening. Early stage and the earlier the stage, the higher the chance of cure. And that is one push that we as medical professionals do push towards getting mammography, being up to date with screening mammography so that we can hopefully find more early breast cancers and potentially cure more patients.
Host: And I'm assuming up-to-date might means that if you don't have cancer in your family, that would be what, once a year, and if you do more often?
Dr. Bagchi: Yes. Generally a once a year mammography is recommended by the society guidelines. Now that again, as you rightly mentioned, changes if there is a history of cancer in the family members, especially breast cancer, ovarian cancer, or any other female body part cancer in any family member. In that case then, the recommendation may shift to every six monthly imaging, depending on how high the risk would be in a particular individual.
Host: So finally, doctor, let's talk about the new medical oncology practice at Regional One Health and how you're using these treatments. Is there anything we haven't covered?
Dr. Bagchi: We actually have been setting up this practice over the last year, year and a half. And based on the current knowledge that I have, I'm only a medical oncologist who treats breast cancer from the medical standpoint. A very important and indispensable cog in the wheel, is the surgeon, the surgical team, because we together, provide a very multidisciplinary care to our patients with breast cancer. All in all other than whatever I've mentioned, we also have some very important tools which we use for patients who have been diagnosed with early breast cancer. Those tools are especially some tests which we do in patients, whether to find out can they benefit from chemotherapy or not? Do they require chemotherapy or not after they had surgery and depending on those tools, which are now approved nationally, we can find out what patient can get, what kind of therapy and personalize treatments for all our patients.
Host: Well, thank you so much, doctor. It's very interesting to hear about these targeted treatments and how you go about making those decisions. It's been a pleasure to talk to you.
Dr. Bagchi: Thank you for having me here. Pleasure.
Host: Dr. Arindam Bagchi is a Medical Oncologist at Regional One Health. To learn more about the treatment of breast cancer, go to regionalonehealth.org/oncology-Maine-campus.
That's regionalonehealth.org/oncology-Maine-campus. Or call 901-545-6262. I'm Alyne Ellis. Thanks for making One On One With Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow. Stay well.
Alyne Ellis (Host): One on One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. I'm Alyne Ellis and our subject today is treatment options for breast cancer. Joining me is Medical Oncologist, Dr. Arindam Bagchi. Welcome and thank you doctor for clarifying such an important issue.
Arindam Bagchi, MD (Guest): Thank you. Pleasure is all mine.
Host: Let's begin with, how do you determine which medical oncology therapies are best to treat a patient's specific breast cancer diagnosis?
Dr. Bagchi: First of all, I'd like to give a brief introduction by saying all breast cancers are not one. Breast cancers can be broadly of three types; hormone positive, HER2 positive or triple negative. These are markers which are tested when the breast cancer is diagnosed and studied under the microscope after the patients get a tissue biopsy. That is where either a needle is taken in and biopsied.
And after that we come to these results. So, the treatments vary widely based on what type of breast cancer it is. nOw coming into the details of the treatments, before starting treatments, we determine what the patient wants. If the patient wants surgery first, if that is an option for early breast cancer, that's always done first. And then after that depending on what risks are there for the patients, we either do hormone therapy for hormone positive breast cancers, or chemotherapy, along with other biological therapies for HER2 positive breast cancers and chemo, and sometimes chemo immunotherapy for triple negative breast cancer. So all in all, it varies widely depending on what exact subtype of breast cancer a patient may have.
Host: So, looking across these three categories, you've delineated, what are some of the latest medical oncology treatment options that you offer for breast cancer patients?
Dr. Bagchi: It's very important to understand medical oncology means medical treatments. A medical oncologist would offer either pills or chemo or immunotherapy, or biological therapy, which most of them are IV treatments to patients. Going one by one. Earlier we used to use chemotherapy for almost all breast cancers if we had to treat them from the medical standpoint. Nowadays for hormone positive breast cancers, some of the recent advancements actually do not warrant the patient to get chemotherapy for hormone positive breast cancers.
And what we do is basically give them pills, targeted therapy and pills and anti hormonal pills. So that's one of the great advancements that we have had over the last few years. Moving on to triple negative breast cancer, which of the three types is more aggressive and associated with worse features. Nowadays, we have chemotherapy with immunotherapy, which was recently approved by the FDA for triple negative breast cancers, which tend to do better than just chemotherapy and for the other subtype, which is HER2 positive breast cancer; we now have biological treatments, antibody treatments, along with chemotherapy which tend to offer better results for patients than just chemotherapy or just doing biological therapy.
Host: So, with all these new advances, what can patients expect in terms of what happens during treatment and the resulting side effects and how long the treatment will last? I'm sure, in each category there's an awful lot to detail.
Dr. Bagchi: This is just a very brief overview. But the way we practice breast medical oncology nowadays is very patient specific. It's personalized to each patient's unique cancer, their health, their stage of the cancer more importantly, and the treatment duration depends on what stage of the cancer they have. For example, a patient with very early, HER2 positive breast cancer, will have potentially one year of treatment. And after that, if they do not show any signs of cancer left, then they can just be followed up with frequent scans and frequent office visits. This would be different for another patient in a different situation.
For example, if they have widespread cancer say triple negative or HER2 positive cancer, then in that case, the treatment durations tend to be much prolonged up until either the cancer is shrinking down or up until the patient is able to tolerate going from months to maybe years and subsequent lines of treatments, other treatments, if one doesn't work and it keeps going on in that stage. For hormone positive breast cancers that we say, if they're early and they can be taken out by surgery; generally we look at five years of treatment, post surgery, but again, this can go higher up to 10 years. And the treatment we are talking about here in hormone positive cases are pills. We take anti-hormone pills. We prescribed them to the patients depending on their profile and features of the cancer, again and take it from that up to five or up to 10 years, again, depending on how the patient can tolerate them.
Host: So, with these new treatments, are we also getting better and have more knowledge about how to handle the side effects?
Dr. Bagchi: Definitely. With chemotherapy the old days, everybody was scared and horrified, okay. We'll have chemotherapy. We'll be sick, deathly. But nowadays, that's not the case. Nowadays chemotherapy is much more tolerable. For example, if you say that for patients who are getting back for their treatments of breast cancer, because we have had so many new medicines and more effective medicines, which can, for example, prevent and treat nausea patients. Nowadays, if they get nausea, then at least something is not given right in that situation because we have such greatly effective anti-nausea medicines. Also we have medicines which can treat side effects, such as nerve side effects. Medicines, which can treat other side effects with hormone therapy, such as hot flashes. We have effective medicines, which treat that. Sometimes patients get bone problems and we have medicines which can prevent their bones from becoming thin or worse and prevent fractures. So all these have together led to supportive care, which has improved a lot over the last few years in patients who are getting medical treatments for their breast cancer.
Host: Now, I know you can't necessarily speak in specifics, particularly when somebody comes to you and is really an advanced stage, but in general, what types of outcomes are you now seeing as a result of these treatments that with the new measures that you're putting in place?
Dr. Bagchi: Yeah. So this, this is again, a very evolving, moving target and the numbers continue to improve, I would say over the last five to eight years. Again, this is very dependent on what is the stage of the patient's cancer that the patient is initially found with. Again, a stage one or stage two hormone positive breast cancer, more than likely, fair better, and will have slightly longer, you know, survival and a great chance for getting cured of the cancer as compared to somebody who comes in with a much advanced stage of the cancer and an aggressive cancer. The numbers would be very specific to stage in which they present.
But overall, if you talk about advanced stage, it has improved a lot. For example, if hormone positive breast cancer, there is an advanced stage patient coming up again, these are averages, different patients can fall in different timeframes of these averages, generally with the first line oral treatments, the average lifespan is about two years. Again, taking it as an average. And after that also we have much more treatments if they do not do well on the first treatment, we can always go to the second of the hormone and targeted treatments. Just as a small example, the numbers are improving.
Again, if we take the last 10 years versus the last four years, the numbers would be on a constant rise and patients are living longer with advanced disease with advanced breast cancers of all the three subtypes over the board.
Host: Could most of the cancers that you see be found with early detection through mammography?
Dr. Bagchi: Yes. Most of the cancers that we do see are early breast cancers, to be honest. Only one third of the patients, roughly 30 to 40% of the patients tend to present as advanced cancers or even the advanced cancer that we do end up seeing are coming from cancers have were known to us many years ago and they just came back.
Mammography is one of the very important tools and it helps us detect breast cancer very early, in early stage so that we can cure it. And that's the importance of screening for breast cancer by mammography. Screening means cancer is found before it causes any symptoms or before it's big enough to cause any trouble. So we find that on screening. Early stage and the earlier the stage, the higher the chance of cure. And that is one push that we as medical professionals do push towards getting mammography, being up to date with screening mammography so that we can hopefully find more early breast cancers and potentially cure more patients.
Host: And I'm assuming up-to-date might means that if you don't have cancer in your family, that would be what, once a year, and if you do more often?
Dr. Bagchi: Yes. Generally a once a year mammography is recommended by the society guidelines. Now that again, as you rightly mentioned, changes if there is a history of cancer in the family members, especially breast cancer, ovarian cancer, or any other female body part cancer in any family member. In that case then, the recommendation may shift to every six monthly imaging, depending on how high the risk would be in a particular individual.
Host: So finally, doctor, let's talk about the new medical oncology practice at Regional One Health and how you're using these treatments. Is there anything we haven't covered?
Dr. Bagchi: We actually have been setting up this practice over the last year, year and a half. And based on the current knowledge that I have, I'm only a medical oncologist who treats breast cancer from the medical standpoint. A very important and indispensable cog in the wheel, is the surgeon, the surgical team, because we together, provide a very multidisciplinary care to our patients with breast cancer. All in all other than whatever I've mentioned, we also have some very important tools which we use for patients who have been diagnosed with early breast cancer. Those tools are especially some tests which we do in patients, whether to find out can they benefit from chemotherapy or not? Do they require chemotherapy or not after they had surgery and depending on those tools, which are now approved nationally, we can find out what patient can get, what kind of therapy and personalize treatments for all our patients.
Host: Well, thank you so much, doctor. It's very interesting to hear about these targeted treatments and how you go about making those decisions. It's been a pleasure to talk to you.
Dr. Bagchi: Thank you for having me here. Pleasure.
Host: Dr. Arindam Bagchi is a Medical Oncologist at Regional One Health. To learn more about the treatment of breast cancer, go to regionalonehealth.org/oncology-Maine-campus.
That's regionalonehealth.org/oncology-Maine-campus. Or call 901-545-6262. I'm Alyne Ellis. Thanks for making One On One With Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow. Stay well.