Breast Cancer Immunotherapy & Radiation Therapy

Although breast cancer has historically been considered immunologically silent, several preclinical and clinical studies suggest that immunotherapy has the potential to improve clinical outcomes for patients with breast cancer. Overall, immunotherapy holds several key advantages over conventional chemotherapeutic and targeted treatments directed at the tumor itself. The common types of immunotherapy include Monoclonal antibodies, Cancer vaccines and Non-specific immunotherapies. One common type of breast cancer immunotherapy drug for breast cancer is Herceptin. This drug binds with specific proteins on breast cancer cells to slow or stop their growth. Your care team may recommend Herceptin to target breast tumors that produce too much of (or overexpress) a protein called HER2, which can also signal more aggressive cancers. Immunotherapy is a promising treatment for breast cancer, including advanced and recurrent forms of the disease. Immunotherapy may be used alone or in conjunction with other breast cancer treatments, such as radiation therapy and chemotherapy.

Radiation Therapy is treatment with high-energy rays or particles that destroy cancer cells. Radiation to the breast is often given after breast-conserving surgery to help lower the chance that the cancer will come back in the breast or nearby lymph nodes. Radiation may also be recommended after mastectomy in patients either with a cancer larger than 5 cm, or when cancer is found in the lymph nodes. Radiation therapy uses a special kind of high-energy beam to damage cancer cells. (Other types of energy beams include light and X-rays.) These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material that cells use to divide. Radiation is an important and often necessary form of anti-cancer therapy because it is able to reduce the risk of recurrence after surgery. Many patients are surprised to discover that having radiation therapy is less difficult than they expected, though the radiation used to damage cancer in your body can also damage healthy cells.

How Radiation Works?? Radiation therapy uses a special kind of high-energy beam to damage cancer cells. (Other types of energy beams include light and X-rays.) These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material that cells use to divide. Over time, the radiation damages cells that are in the path of its beam — normal cells as well as cancer cells. But radiation affects cancer cells more than normal cells. Cancer cells are very busy growing and multiplying — 2 activities that can be slowed or stopped by radiation damage. And because cancer cells are less organized than healthy cells, it's harder for them to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy, normal cells are better able to repair themselves and survive the treatment.

When Is Radiation Appropriate??  Radiation therapy has an important role in treating all stages of breast cancer because it is so effective and relatively safe. It may be appropriate for people with stage 0 through stage III breast cancer after lumpectomy or mastectomy. Radiation can also be very helpful to people with stage IV cancer that has spread to other parts of the body. Women who are pregnant should not have radiation. Radiation is never safe during pregnancy.

Types of Radiation Therapy:- There are three main types of radiation which are External Radiation, Internal Radiation and Intraoperative Radiation. External radiation is the most common type of radiation, typically given after lumpectomy and sometimes, mastectomy. In this section, you can read about how external radiation is given. Internal radiation is a less common method of giving radiation. It is being studied for use after lumpectomy. In this section, you can read about how radiation is delivered inside the breast. Another relatively new type of radiation to treat breast cancer is intraoperative radiation therapy (IORT). IORT is given during lumpectomy surgery after the cancer has been removed. In this section you can read about how intraoperative radiation therapy is given.

Radiotherapy is a cornerstone of cancer care in non-metastatic patients. It has been incorporated into the treatment regimens of major tumor histologies with curative intent, and is broadly applied for almost any tumor type in the metastastic setting to alleviate symptoms. The cytotoxic effects of radiotherapy have primarily been attributed to double strand DNA damage; however, recent evidence suggests that its immunomodulatory effects can contribute to its therapeutic efficacy. This synergistic potential from combining radiotherapy and immunotherapy may have a role in patients with locally advanced or metastatic cancer.

Immune checkpoint inhibitors have been developed to blunt tumor-based immunosuppressive signals. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) are protein receptors expressed on T-cells whose engagement with their ligands (B7-1 or B7-2, and B7-H1 or B7-H2 respectively) limits T cell activity. The CTLA-4 inhibitor (ipilimumab) and the PD-1 inhibitors (pembrolizumab and nivolumab) have been approved by the FDA for the treatment of metastatic melanoma (all of the agents) and squamous cell lung cancer (nivolumab). Interestingly, an abscopal or off-target effect has been reported in a patient with metastatic melanoma where the addition of radiotherapy to ipilimumab led to tumor response in non-radiated lesions in addition to the radiated lesion [1]. This case report has stimulated significant excitement for the synergism between radiotherapy and immunotherapy in the clinical setting.

  • Non Specific Immunotherapies
  • Immunotheraputic Approaches to Breast Cancer
  • Immune Checkpoints & Cancer Therapy
  • How Radiation Works & When is Radiation Appropriate ?
  • Types of Radiation Therapy, Radiotherapy New Techniques and Protocol
  • Controversies in Radiation Therapy
  • Monoclonal Antibodies
  • Cancer Vaccines

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