Find Effective Drugs before Starting the Therapy!

No two cancer therapies are the same!

There is a wide range of different drugs which can be applied in treatment of breast cancer. This treatment includes classical chemotherapeutic substances, yet also anti-hormonal drugs and new targeted drugs are used. Which medication should be prescribed depends on different factors, e.g. the cancer stage and the general condition of the patient. In order to choose the right therapy there are medical guidelines for physicians. However, in some situations the guidelines do not give clear recommendations and propose equivalent treatment options.

Diagnostic assays can help to identify effective and ineffective drugs before the start of a therapy. The available spectrum of therapeutics can thereby be limited on the most promising substances. Our diagnostics contribute avoidance of unnecessary side effects as a consequence of an ineffective therapy and save valuable treatment time. Therefore we offer the following diagnostic tests:

  • CTR-Test® - An efficacy test working on living tumor cells
  • PCDx™ - A tumor-biomarker-analysis working on non-living, conserved tumor cells
  • Guardant360® - A tumor-biomarker-analysis working with blood

Guidelines for the Treatment of Breast Cancer

Hereafter you can find an overview about guideline-recommendations, which are elaborated by medical specialist associations:

A part and parcel of the medical breast cancer treatment is the anti-hormonal therapy. It has to be distinguished if the woman's menopause has already set in or not. If a patient has not yet entered menopausal years, GnRH-analogs can be prescribed additionally. These analogs result in an elimination of the ovarian function. Though not all breast tumors respond to an anti-hormonal therapy. The efficacy of an anti-hormonal treatment can be tested in advance of therapy start.

Chemotherapeutics and targeted drugs are also a part of standard therapy. Generally two or three chemotherapeutic agents are used in a combination therapy.

Anti-Hormonal Drugs

locally limited primary disease premenopausal tamoxifen
tamoxifen + GnRH-analogs
postmenopausal aromatase inhibitors
tamoxifen
local recurrence   aromatase inhibitors
tamoxifen
distant metastases premenopausal aromatase inhibitors + GnRH-analogs
tamoxifen + GnRH-analogs
high-dose gestagens
postmenopausal aromatase inhibitors
fulvestrant
high-dose gestagens

 

Chemotherapeutics and Targeted Drugs

locally limited primary disease chemotherapy anthracyclines (e.g. doxorubicin, epirubicin)
taxanes
anthracyclines + taxanes
targeted drugs trastuzumab
local recurrence   selection of substances appropriate to previous therapy
distant metastases chemotherapy alkylating agents
anthraquinones
anthracyclines
capecitabine
eribulin
fluoropyrimidines
platinum complexes
taxanes (e.g. docetaxel, paclitaxel)
vinorelbine
targeted drugs bevacizumab
lapatinib
trastuzumab

This tables are based on the "Interdisziplinäre[n] S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms", issued by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF), the German Cancer Society (Deutsche Krebsgesellschaft, DKG) and the Germany Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) [1].


Efficacy Tests of Drugs for Breast Cancer

Which drugs can be tested in their efficacy by our diagnostic tests? The following tables give you information on the substances recommended by the guidelines, but also about further drugs which can be found as additional treatment options in literature. These substances are classified in the following categories:

In addition the frequently used combination therapies are listed below.

The testabilities for the CTR-Test®  and the PCDx™ are also given.

Chemotherapeutics

Substance name Efficacy testable by living tumor & blood (living cells) Efficacy testable by archived tumor (FFPE) Efficacy testable by blood (plasma) Reference
5-fluorouracil (5-FU) yes yes not yet [1], [2], [3], [4]
capecitabine yes yes not yet [1], [2], [3], [4]
carboplatin yes yes yes [1], [2], [3], [4]
cisplatin yes yes yes [2], [4]
cyclophosphamide yes no biomarkers yet not yet [1], [2], [3], [4]
docetaxel yes yes not yet [1], [2], [3], [4]
doxorubicin yes yes not yet [1], [2], [3], [4]
doxorubicin (liposomal) yes yes not yet [1], [2]
epirubicin yes yes not yet [1], [2], [3], [4]
eribulin no validation yet yes not yet [1], [3], [4]
gemcitabine yes yes not yet [1], [2], [3], [4]
ixabepilone no validation yet no biomarkers yet not yet [4]
methotrexate no not yet not yet [1], [2]
paclitaxel yes yes not yet [1], [2], [3], [4]
vinorelbine yes not yet not yet [1], [2], [3], [4]


 

Targeted Drugs

Substance name Efficacy testable by living tumor & blood (living cells) Efficacy testable by archived tumor (FFPE) Efficacy testable by blood (plasma) Reference
bevacizumab no yes not yet [1], [3], [4]
everolimus no validation yet yes yes [4]
lapatinib no validation yet yes yes [1], [3], [4]
palbociclib no validation yet yes not yet [4]
pertuzumab no validation yet yes yes [1], [3], [4]
trastuzumab no validation yet yes yes [1], [2], [3], [4]
trastuzumab emtansine no validation yet yes yes [3], [4]

 

Anti-Hormonal Drugs

Substance name Efficacy testable by living tumor & blood (living cells) Efficacy testable by archived tumor (FFPE) Efficacy testable by blood (plasma) Reference
anastrozole not possible yes yes [4]
ethinyl estradiol no validation yet no biomarkers yet not yet [4]
exemestane not possible yes yes [1], [3], [4]
fluoxymestrone not possible no biomarkers yet not yet [4]
fulvestrant no validation yet yes not yet [3], [4]
goserelin not possible no biomarkers yet yes [4]
letrozole not possible yes yes [4]
leuprorelin not possible not yet not yet [4]
megestrol no validation yet yes not yet [4]
tamoxifen yes yes yes [1], [3], [4]
toremifene no validation yet yes not yet [4]

 

Frequently Used Combination Therapies

Substance name Combination name Reference
5-fluorouracil + cyclophosphamide + doxorubicin FAC [2]
5-fluorouracil + cyclophosphamide + epirubicin FEC [2]
5-fluorouracil + cyclophosphamide + methotrexate CMF / Bonadonna [2]
bevacizumab + capecitabine   [1], [3]
bevacizumab + paclitaxel   [1]
capecitabine + docetaxel   [1]
capecitabine + lapatinib   [1], [2]
capecitabine + paclitaxel   [1], [4]
capecitabine + trastuzumab   [1], [4]
capecitabine + vinorelbine   [1]
carboplatin + docetaxel + trastuzumab TCH [2]
carboplatin + gemcitabine   [2]
cisplatin + gemcitabine   [2]
cisplatin + gemcitabine + trastuzumab   [2]
cyclophosphamide + docetaxel TC [2], [3]
cyclophosphamide + docetaxel + doxorubicin TAC [2]
cyclophosphamide + doxorubicin AC [2], [3]
cyclophosphamide + doxorubicin + paclitaxel   [2]
cyclophosphamide + epirubicin EC [2]
cyclophosphamide + epirubicin + paclitaxel ETC [2]
docetaxel + doxorubicin   [1]
docetaxel + epirubicin   [2]
docetaxel + gemcitabine   [1]
docetaxel + pertuzumab + trastuzumab   [2], [3], [4]
docetaxel + trastuzumab   [2], [4]
doxorubicin + paclitaxel   [1]
epirubicin + paclitaxel EP [1], [2]
gemcitabine + paclitaxel   [1]
gemcitabine + vinorelbine   [1]
lapatinib + trastuzumab   [3], [4]
paclitaxel + trastuzumab   [2]

The drugs listed here were identified as potential therapy options after an accurate literature research. Completeness cannot be guaranteed. Status: September 2016.

 

Sources

[1] Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms; Langversion 3.0 - 2012; Leitlinienprogramm Onkologie der AWMF

[2] Engelhardt, Monika; Berger, D.; Duyster, J.; Mertelsmann, R. (Hrsg.): Das Blaue Buch: Chemotherapie-Manual Hämatologie und Internistische Onkologie. Berlin, Heidelberg: Springer, 2014 — ISBN 978-364-24174-1-2

[3] Leitlinie Mammakarzinom der Frau der DGHO (Onkopedia) – Stand Juni 2016

[4] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) – Breast Cancer; Version 2.2016

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