A Review Article on

“The Treatment of Breast Cancer”

By
Raihan Biswas
University Roll no. – 35401920021.
Registration no. – 203540201910043.
B.Pharm, 4th Year, 8th Semester

Under the guidance of

Mr. Nibir Ghosh
M.Pharm, Assistant Professor, ECPT

EMINENT COLLEGE OF PHARMACEUTICAL TECHNOLOGY BARBARIA,

BARASAT Jagannathpur, West Bengal - 700126, Kolkata

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 EMINENT COLLEGE OF PHARMACEUTICAL TECHNOLOGY
BARBARIA, BARASAT
Jagannathpur, West Bengal - 700126, Kolkata

CERTIFICATE OF APPROVAL

I hereby recommend that the project work has been prepared under my supervision in
the Division of Pharmacy of Eminent College of Pharmaceutical Technology by Raihan
Biswas entitled "The Treatment of Breast Cancer: A Review Article" he accepted in the
fulfillment of the requirement for the B. Pharm 8th Semester.

Nibir Ghosh Dr. Kaushik Biswas Prof.(Dr.) Suchandra Sen

Assistant Professor, ECPT Vice-Principal & H.O.D., ECPT Principle, ECPT

Evaluator

1.

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 CERTIFICATE FROM THE PRINCIPAL

This is to certify that the "THE TREATMENT OF BREAST

CANCER: A Review Article” is a Bonafede review article done

by RAIHAN BISWAS; in partial fulfilment of the requirements

for the degree of "Bachclor of Pharmacy" of the Mauluna Abul

Kalam Azad University of Technology, Kolkuta.

Prof (Dr.) Suchandra Sen

Principal,Eminent College Of Pharmaceutical Technology

Barbaria,Barasat,Kolkata-700126

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 DECLARATION BY THE CANDIDATE

I, hereby declare that " The Treatment of Breast Cancer : A Review

Article " is my own work that has not been submitted for any degree or
examination in any other university, and that all the sources I have used of
quoted have been indicated and acknowledged by complete references.

Raihan Biswas, B.Pharm,4th Year, 8th Semester

Eminent College Of Pharmaceutical Technology

Barbaria,Barasat,Kolkata-70012

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 ACKNOWLEDGEMENT

I would like to express my profound gratitude to principal

madam of Eminent College of Pharmaceutical Technology Mrs
Dr. Suchandra Sen , of Pharmacology department, and Vice-
Principal of Eminent College of Pharmaceutical Technology Mr
Dr. Kausik Biswas sir for their contributions to the completion of
my project titled

I would like to express my special thanks my Guide Mr. Nibir

Ghosh Sir for his time and efforts ,he provided throughout the
year. Your useful advice and suggestions were really helpful to
me during the project's completion. In this aspect, I am eternally
grateful to you.

I would like to acknowledge that this project was completed

entirely by me and not by someone else.

Date :
Place : Raihan Biswas

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 Index

1. Abstract ...…………………………………………… .... Page - 01

2. Introduction ……………………………………....……… Page 01 – 02

3. Classification …………………………………………… . Page 03-05

4. Drugs ………………………………………………..…… Page 05

5.Treatment……….. ………………………………………… Page 05– 09

6.Conclusion ……………………………………...…………. Page - 10

7. References ………………………………………………… Page 11 - 12

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 The Treatment of Breast Cancer:
A Review Article

ABSTRACT :

Breast cancer, a complex disease influenced by genetic, hormonal, and environmental

factors, poses significant challenges in both diagnosis and treatment. Advancements in
screening and early detection have led to improved outcomes, yet disparities in access
to health care and screening programs persist, particularly in undeserved
populations.Treatment strategies for breast cancer have evolved, focusing on
personalized medicine and targeted therapies tailored to individual tumor characteristics.
These strategies include surgery, radiation therapy, chemotherapy, hormone therapy,
targeted therapy (such as HER2-targeted drugs), and immunotherapy. Despite these
advancements, challenges such as drug resistance, treatment toxicity, and the
development of metastatic disease remain significant hurdles in managing breast
cancer.Moreover, disparities in access to novel treatments and clinical trials exacerbate
inequities in care, highlighting the need for greater efforts in health care access and
equity. Ongoing research efforts aim to address these challenges by developing
innovative therapies, improving treatment efficacy, and advancing precision medicine
approaches to ultimately reduce the burden of breast cancer on patients and society.

Keywords: Breast cancer, Genetic, Disparities, Screening, Targeted therapies, HER2-

targeted drugs

Introduction:
Breast cancer is a multifaceted and potentially devastating disease that arises from the
uncontrolled growth of abnormal cells in the breast tissue. It is the most commonly
diagnosed cancer among women globally, with improving survival rates resulting in 2.6
million US survivors. Although it can also affect men, it is less frequent. The disease
typically begins within the milk-producing glands (lobules) or the ducts that carry milk
to the nipple, but it can also originate in other breast tissues, such as the fatty or
connective tissue(1). The formation of malignant tumors in the breast marks the onset

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of breast cancer, which has the potential to invade adjacent tissues and metastasize to
distant organs, leading to life-threatening complications.
Breast cancer encompasses a spectrum of subtypes, each characterized by distinct
molecular and genetic profiles, clinical behaviors, and treatment responses. Various
factors contribute to the development of breast cancer, including genetic predisposition,
hormonal influences, environmental exposures, and lifestyle behaviors. Notably,
mutations in genes such as BRCA1 and BRCA2 significantly elevate the risk of breast
cancer, emphasizing the genetic underpinnings of the disease. Hormonal factors,
particularly estrogen and progesterone, play a pivotal role in breast cancer pathogenesis,
with prolonged exposure to these hormones associated with an increased risk,
especially in postmenopausal women. Environmental factors, including ionizing
radiation, certain chemical pollutants, and lifestyle choices such as obesity, alcohol
consumption, and physical inactivity, also contribute to the disease burden. Age is a
significant factor, with most cases occurring in individuals over 50. It is a globally
prevalent disease, with over 2 million new cases in 2020 (2).
Early detection plays a critical role in mitigating the impact of breast cancer, allowing
for prompt intervention and improved treatment outcomes. Screening modalities such
as mammography, clinical breast examinations, and breast self-examinations serve as
invaluable tools in detecting breast abnormalities at an early, more treatable stage.
Following diagnosis, treatment strategies are tailored to the individual's unique tumor
characteristics, disease stage, overall health status, and personal preferences. Surgical
interventions, encompassing lumpectomy or mastectomy, are often employed to excise
the tumor and surrounding tissue, with lymph node evaluation performed to assess for
metastasis. Adjuvant therapies, including chemotherapy, radiation therapy, hormone
therapy, and targeted therapy, may be administered to eradicate residual cancer cells,
minimize the risk of recurrence, or shrink tumors prior to surgery. Despite significant
strides in breast cancer research and treatment, persistent challenges remain, including
disparities in access to care, sub optimal treatment efficacy, and the enduring psycho
social impact of the disease on patients and their families. Continued efforts to raise
awareness, promote early detection, advance research initiatives, and enhance support
services are imperative in the ongoing battle against breast cancer, as we strive towards
a future where this devastating disease is eradicated(3).

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 Classification :
The pathologist classifies the cancer according to grade. A ''well-differentiated'' tumor
for example is low grade and resembles normal tissue. A ''poorly differentiated'' tumor
is composed of disorganized cells and, therefore, does not look like normal tissue and is
termed high grade. Some are ''moderately differentiated'' or intermediate grade as
well(5).

Breast cancer is usually, but not always, primarily classified by its histological
appearance. Some of the histological types include

Ductal Carcinoma insitu (DCIS)

This signifies a very early form of cancer that has not spread. DCIS is a type of early
breast cancer inside of the ductal system that has not attacked the nearby tissue. It is
one of the common types of non-invasive cancer (4).

Infiltrating or invasive ductal carcinoma (IDC)

This is the most common type of breast cancer. It starts in the milk ducts and spreads to
surrounding tissues. This can also spread to other parts of the body via lymph channels
and blood stream(4).

Medullary carcinoma

This forms around 15% of all breast cancers. It affects middle aged women more
commonly and the cellular histology resembles the medulla (gray matter) of the
brain(5).

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Lobular Carcinoma in situ (LCIS)

This is a rarer form of non-invasive tumor. It usually does not develop into invasive
cancer. LCIS is more of a “marker” or signal that breast cancer may develop. LCIS has
recently been renamed lobular neoplasia(6)

Tubular carcinoma

The cancer cells appear like tiny tubules. This type of breast cancer is typically found in
women aged 50 and above. This tumor responds well to treatment(7)

Mucinous carcinoma or colloid

This is rare type of invasive breast cancer that rarely spreads to the lymph nodes. The
cancer cells produce mucus and these cells are distinct from normal cells under a
microscope. The mucous and cancer cells combine to form jelly-like tumors(7).

Paget’s disease

This leads to an eczema-like change in the skin of the nipple. There is itchiness, scaling
and oozing discharge from the nipple. 90% of the women who experience these
symptoms have an underlying breast cancer. Paget’s Disease can occur at any age but
will more likely occur in women who are in their 50s(7).

Inflammatory breast cancer

This is a rare but aggressive type of breast cancer. The cancer leads to blockage of the
lymph vessels in the skin of the breast. The cancer appears to cover the breast over a
large area like a sheet rather than a lump. The breast appears swollen, red and
inflamed(7).

Triple negative breast cancer

Breast tumor that is negative for estrogen receptor (ER), progesterone receptor (PR)
and HER2/neu proteins(7).

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Metastatic breast cancer

This is a later stage of breast cancer when it has spread to other organs like liver, brain,
bones etc(7)

Drugs or Treatment:
Several drugs are employed in breast cancer treatment, tailored to individual tumor
characteristics and patient needs.

 Trastuzumab (Herceptin): Targeting HER2-positive breast cancer, Herceptin

inhibits HER2 protein, slowing tumor growth.(5)
 Palbociclib, Ribociclib, Abemaciclib: CDK4/6 inhibitors used in HRpositive,
HER2-negative advanced breast cancer, hindering cell cycle progression.(6)
 Tamoxifen, Fulvestrant: SERMs and SERDs block estrogen signaling in HR-
positive breast cancer, impeding tumor growth.(7)
 Anastrozole, Letrozole, Exemestane: Aromatase inhibitors reduce estrogen
levels in HR-positive breast cancer, slowing tumor growth.(8)
 Olaparib, Talazoparib: PARP inhibitors exploit DNA repair deficiencies in
breast cancer cells, leading to cell death, especially in BRCA-mutated tumors.(9)
 Pembrolizumab, Atezolizumab: Checkpoint inhibitors unleash the immune
system to attack cancer cells, under investigation for breast cancer treatment.(10)
 Bevacizumab: Angiogenesis inhibitor targeting VEGF, often combined with
chemotherapy for metastatic breast cancer.(11)
 Doxorubicin, Paclitaxel: Chemotherapy drugs used in various regimens,
typically combined with targeted or hormonal therapies for enhanced efficacy.(12)

Treatment :

1. Immunotherapy:

Checkpoint Inhibitors:

Immunotherapy has emerged as a groundbreaking approach in breast cancer treatment,

particularly through the use of checkpoint inhibitors. These drugs, such as
Pembrolizumab and Atezolizumab, target immune checkpoints like PD-1 and PD-L1.

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By inhibiting these checkpoints, they unleash the body's immune system, enabling it to
recognize and destroy cancer cells.

Although checkpoint inhibitors were initially more successful in cancers with high
mutation rates like melanoma and lung cancer, ongoing research is exploring their
efficacy in breast cancer, especially in triple-negative breast cancer (TNBC) sub types.
Early clinical trials have shown promising results, sparking interest in integrating
immunotherapy into standard treatment regimens for breast cancer patients(13)(14)(15).

2. Targeted Therapies:

HER2-Targeted Therapies:

HER2-targeted therapies, such as Trastuzumab (Herceptin) and Pertuzumab, have

revolutionized the management of HER2-positive breast cancer. By specifically
targeting the HER2 protein, these drugs have significantly improved outcomes in
patients with this aggressive subtype of breast cancer. Ongoing research aims to refine
existing therapies and develop novel agents to overcome resistance mechanisms and
further enhance treatment efficacy. Emerging HER2-targeted therapies, including
antibody-drug conjugates and bispecific antibodies, hold promise for expanding
treatment options and improving survival rates in HER2-positive breast cancer
patients(16)(17)(18).

3. Precision Medicine:

Liquid Biopsies:

Liquid biopsies, including circulating tumor DNA (ctDNA) analysis, offer a non-
invasive method to monitor tumor dynamics and treatment response. These tests detect
genetic alterations and mutations in ctDNA shed by cancer cells, providing valuable
insights into tumor evolution, treatment resistance, and actionable targets for
personalized therapy. Liquid biopsies have the potential to revolutionize cancer
management by enabling real-time monitoring of disease progression and guiding
treatment decisions based on individual tumor profiles(16)(17)(18) .

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Genomic Profiling:

Advances in genomic profiling, such as next-generation sequencing (NGS), have

transformed our understanding of breast cancer biology. By identifying specific genetic
alterations and molecular subtypes, genomic profiling informs treatment decisions and
enables the development of targeted therapies tailored to individual patients. Integrating
genomic data into clinical practice facilitates precision medicine approaches, leading to
improved outcomes and reduced toxicity. Genomic profiling also holds promise for
identifying novel therapeutic targets and predicting treatment responses, paving the way
for personalized cancer care(16)(17)(18) .

4.Hormone Therapies:

CDK4/6 Inhibitors:

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, including Palbociclib, Ribociclib,

and Abemaciclib, have transformed the management of hormone receptor-positive
(HR+) metastatic breast cancer. These agents disrupt cell cycle progression by
inhibiting CDK4/6, thereby slowing tumor growth and delaying disease progression.
Combinations of CDK4/6 inhibitors with endocrine therapies have demonstrated
significant improvements in progression-free survival and overall survival, establishing
them as standard-of-care options in the first-line treatment setting. Ongoing research
focuses on identifying biomarkers of response and resistance to CDK4/6 inhibitors to
optimize patient selection and treatment outcomes(19)(20) .

Aromatase Inhibitors:

Aromatase inhibitors, such as Anastrozole, Letrozole, and Exemestane, remain

cornerstone therapies in the management of HR+ breast cancer. By blocking estrogen
synthesis, these agents effectively suppress estrogen signaling and inhibit tumor growth.
Ongoing research focuses on optimizing treatment strategies, including sequencing and
duration of therapy, to maximize clinical benefits and minimize adverse effects.
Combination therapies incorporating aromatase inhibitors with novel targeted agents or
immunotherapies are being explored in clinical trials to enhance treatment efficacy and
overcome resistance mechanisms in HR+ breast cancer patients(20).

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5.Novel Drug Delivery Systems:

Nanotechnology:

Nanoparticle-based drug delivery systems hold tremendous potential for improving the
efficacy and safety of breast cancer therapies. By encapsulating chemotherapeutic
agents within nanoparticles, drug delivery can be targeted specifically to tumor cells,
minimizing off-target effects and reducing systemic toxicity. Additionally,
nanoparticles can be engineered to incorporate targeting ligands or stimuli-responsive
moieties, further enhancing their specificity and therapeutic index. Ongoing research
aims to translate these promising pre clinical findings into clinically viable
nanomedicines for breast cancer treatment. Nanoparticle-based formulations of
chemotherapy drugs, such as paclitaxel and doxorubicin, have shown promising results
in pre clinical studies and early-phase clinical trials, demonstrating improved tumor
penetration, enhanced therapeutic efficacy, and reduced side effects compared to
conventional formulations(21)(22).

6. Combination Therapies:

Dual Targeting:

Combinatorial approaches that target multiple signaling pathways or mechanisms of

resistance represent a promising strategy to overcome treatment resistance and improve
outcomes in breast cancer. By simultaneously inhibiting complementary pathways or
synergistically enhancing therapeutic effects, combination therapies have the potential
to achieve deeper and more durable responses(18).

Clinical trials are underway to evaluate novel combinations of targeted agents,

immunotherapies, and traditional cytotoxic chemotherapy, aiming to identify optimal
treatment regimens for different breast cancer subtypes. Biomarker-driven approaches
focus on identifying patient subpopulations most likely to benefit from specific
combination therapies, facilitating personalized treatment strategies and maximizing
clinical outcomes(18).

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These advancements in breast cancer therapy underscore the transformative potential of
precision medicine, immunotherapy, and targeted therapies in improving patient
outcomes and quality of life. Continued research and clinical innovation hold the
promise of further refining existing treatments and developing novel therapeutic
strategies to address the evolving challenges of breast cancer management(19)(20)(21).

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Conclusion:

Breast cancer treatment has seen incredible progress with the introduction of targeted
therapies, immunotherapies, and precision medicine. These treatments offer more
personalized options for patients and have shown promising results in improving
outcomes. Targeted therapies like trastuzumab and pertuzumab, which target specific
molecules in cancer cells, have been particularly successful for HER2-positive breast
cancer. Immunotherapies, such as pembrolizumab, harness the body's immune system
to fight cancer cells, showing encouraging results in certain types of breast cancer.
Precision medicine, which matches treatments to the genetic makeup of tumors,
represents a significant shift in cancer care. By identifying specific mutations driving
cancer growth, clinicians can tailor treatments to individual patients, potentially
improving response rates.

However, challenges remain. Breast cancer is complex and heterogeneous, requiring

tailored treatment strategies. Additionally, the high costs of newer treatments and the
emergence of treatment resistance pose barriers to access and effectiveness. To address
these challenges, ongoing research, collaboration among healthcare providers, and
policy changes are needed. Clinical trials play a vital role in evaluating new therapies
and informing treatment guidelines. Despite the challenges, advancements in breast
cancer therapy offer hope for patients and their families. Continued investment in
research, patient support, and collaboration will be crucial in improving outcomes and
quality of life for those affected by breast cancer.

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