Systemic therapy

Chemotherapy

If  chemotherapy is indicated because of an aggressive biology of the tumor, it is in most cases beneficial to start with the chemotherapy before surgery (=neoadjuvant chemotherapy). In patients with a Her-2 positive tumor subtype chemotherapy is combined with antibodies (Trastuzumab, Pertuzumab).
After breast cancer diagnosis you will have many questions about timing, possible side effects and their management of different therapy regimens which I would like to discuss with you individually.

Antihormonal therapy

In the case of hormone-dependent breast cancer antihormonal therapy with either tamoxifen or aromatase inhibitors is indicated. In premenopausal patients depending on age and tumor subtype a combination with a GnRH analogon (Zoladex) is indicated, which is injected subcutaneously once a month.
These therapies have possible side effects like hot flushes, sleep disorder, weight gain or arthralgia leading to a compromised quality of life.
As a gynaecologist and breast cancer specialist I will discuss with you different strategies to maintain a good quality of life.

New therapies in locally advanced and metastatic breast cancer

Hormonreceptor positive, Her-2 negative locally advanced or metastatic breast cancer patients could benefit from the therapy with CDK4/6 inhibitors (Palbociclib, Ribociclib, Abemaciclib). This oral medication combined with antihormonal therapy has been shown to achieve high response rates with a good quality of life.
If progression occurs, the tumor tissue of these patients should be tested for a PIK3Ca-mutation. This mutation can be found in 40% of hormone-dependent breast cancer patients and these patients would benefit of a PI3K inhibitor therapy (Alpelisib), which is also an oral medication and comes along with a good quality of life.
Patients with locally advanced or metastatic triple negative breast cancer could benefit from a kind of immunotherapy which is combined with chemotherapy: if their tumors would express PD-L1, they could be treated with PD-L1 inhibitors (Atezolizumab).