Chemotherapy for male breast cancer
Chemotherapy, a chemical treatment, is used to kill cancer cells that can spread using the blood or lymphatic system. The medication(s) can be given by vein (intravenously) or by mouth. Systemic treatment, either adjuvant or neoadjuvant, is often recommended to patients with early stage invasive cancers. Adjuvant chemotherapy is
administered after surgery has removed all the identified cancer but the breast cancer team believes that it is likely that straggling cancer cells have been left behind. These cancer cells cannot be identified on imaging tests or in the blood. Because this treatment is administered through the blood, it is designed to kill remaining undetectable cancer cells before they have a chance to form a metastatic lesion in distant organs such as the bone, lung or liver. In adjuvant treatment, multiple chemotherapy drugs are usually administered for a 3–6 month time period. Some HER- 2/neu targeted therapies may be given for one year.
Neoadjuvant chemotherapy often uses the same chemotherapy drugs; however, the medicines are administered after the cancer is diagnosed and before surgery. The UC Cancer Center breast cancer team will discuss with you whether adjuvant or neoadjuvant treatment is preferred. Chemotherapy can also be used for advanced breast cancers where the tumor has already spread under the arms or to other distant sites. Because many different types of chemotherapy are available, the type, course of treatment and side effects will depend on the biology of the cancer and the patient’s overall health and personal wishes.
Hormone therapy for male breast cancer
Hormone therapy is another form of systemic treatment carried by the blood stream. It is usually given in the adjuvant setting after surgery has been completed or radiation treatment has concluded, although it can also be offered before surgery as a neoadjuvant treatment. Many breast cancers grow in response to estrogen. While
estrogen is typically considered a female hormone, men also have levels of estrogen. However, these blood levels are usually much lower in men compared to women. Approximately 80% of male breast cancers are hormone receptor-positive, which makes them more likely to respond to hormone treatments. These hormone drugs are only effective in estrogen and/or progesterone receptor-positive tumors. First-line hormone treatment for men with breast cancer is tamoxifen, a selective estrogen receptor modulator.
Tamoxifen is a pill taken daily, and it reduces the chances of hormone sensitive cancer returning by approximately 50%. In early stage breast cancer, we recommend receiving the drug for five years. Although newer studies in women suggest years of treatment may be more beneficial than five years, we do not have data on extended use of the drug in men. Tamoxifen is also used to treat advanced breast cancers. The most common side effects of tamoxifen include fatigue, hot flashes and sexual problems. Although less common, blood clots in the leg or lung can also occur.
Although other classes of hormone drugs, including aromatase inhibitors and estrogen receptor down regulators, are often used in the treatment of hormone-dependent breast cancers in women, these drugs have been less studied in male breast cancer. Luteinizing hormone-releasing hormone analogs (LHRH analogs) such as leuprolide and goserelin can affect the pituitary gland, which lowers the male hormone, testosterone. These drugs are administered as monthly shots, and they are sometimes prescribed alone or in combination with an aromatase inhibitor to treat advanced breast cancer in men.
HER-2/neu targeted therapy for male breast cancer
Some male breast cancers will be stimulated by too much HER-2/neu protein on the outside of cancer cells. These cancers are called HER-2/neu positive, and special tests (immunostaining and fluorescent in situ hybridization) can be performed on the breast cancer to determine if the cancer is driven by HER-2/neu. Several HER-2/neu targeted treatments are currently approved for breast cancer in women. Unfortunately, studies have not been performed in men yet.
However, general treatment guidelines for men are the same as for women. Targeted treatment against these cancers can include the use of trastuzumab (Herceptin) which has been well studied in HER-2/neu positive breast cancer in women. In early stage female breast cancer, this monoclonal antibody improves survival by approximately 50%. Trastuzumab (Herceptin), a monoclonal antibody that attaches to HER-2/neu, can slow the growth of HER-2/neu positive cancers. The drug is given by vein (intravenously) every three weeks, and for women it has been approved in neoadjuvant, adjuvan, and advanced settings.
Side effects are uncommon but can include alteration in heart pumping, nausea, weakness, fatigue and headache. Assessment of heart function is routinely performed throughout the course of treatment. Pertuzumab (Perjeta) is also a monoclonal antibody that attaches to the HER2-neu protein in a different location than trastuzumab. This drug is often prescribed with trastuzumab and chemotherapy drug, docetaxel, in the neoadjuvant, adjuvant and advanced female breast cancer setting. Another HER2 targeted treatment includes Ado-trastuzumab emtansine (TDM-1, Kadcyla). This drug is a fusion product: monoclonal antibody, trastuzumab, combined with a chemotherapy drug (DM-1). It is currently approved for the treatment of advanced female breast cancer. Lapatinib (Tykerb) is an oral pill that can target the HER2-neu protein, and it is prescribed primarily for the treatment of advanced HER2-neu positive cancer in which trastuzumab is no longer effective.