In 2019, France began applying targeted therapy for the purposes of multiple breast cancer metastases treatment.
If drugs like Avastin have long spread around the world, the use of Abemaciclib requires close monitoring by doctors with targeted therapy specializations.
This is due to the fact that the possible outcome of this drug is strictly individual in each and every case and doctor must clearly understand what exactly is happening to the patient and how well the patient tolerates this treatment.
The use of this drug in clandestine conditions is not recommended (as it is often done, drugs are ordered abroad for use at home and administration by the local doctors).
Where can breast cancer metastasize?
Metastatic breast cancer is breast cancer whose cells have spread to the other parts of the body.
Despite the fact that breast cancer cells can spread to almost any part of the body, they most often metastasize to the bones. Metastases can be also commonly found in the lungs, liver, brain, and skin. This secondary cancer type is called metastatic cancer.
If metastatic breast cancer is your primary diagnosis, it means that cancer cells have been detected both in the breast and in the other parts of the body. In this case, even if the cancer cells have spread to the other parts of the body, the main treatment will be targeted to the primary tumor.
The first stage localized breast cancer usually responds very well to the treatment, even if though the quality of life might deteriorate.
However, it happens sometimes that metastases are being detected only during the treatment of the primary tumor.
How is metastatic breast cancer treated?
Breast cancer of the third and the fourth stage. There are two possible scenarios: more and less positive ones.
Up until today the treatment of oncology was defining metastases as a synonym to the death sentence, however, advanced French medicine doesn't consider this relevant anymore.
Radiosurgery for the treatment of the brain, bones and lung metastases.
Unfortunately, due to the lack of high-quality equipment and the low competence of employees interpreting the images, metastases may not be immediately visible or their exact number may not be correctly determined.
This is extremely important for radiosurgery and stereotactic radiotherapy to take place, as the exact number of metastases is needed in order to remove each of them. An unnoticed or forgotten metastasis can negate the entire treatment.
That is why, when conducting the treatment in France, a foreign patient is asked to redo the screening, necessary for the treatment.
The approximate price of a brain MRI with contrast on the latest Tesla machine is around 160 euros (Nice).
Two different scans are made and they are fused in specific software, which makes it possible to see things that are not visible when conducting only one type of screening.
If there are up to 7-9 metastases, they are treated by the means of radiosurgery.
This non-invasive procedure lasts up to 5 minutes per metastasis.
For instance, the same procedure, performed by the older devices, such as gamma knives, may last up to 40 minutes.
But the newer generation of devices, such as Versa HD, allow it to remove the formation in a matter of minutes.
What is metastatic radiosurgery?
Advanced modern devices are proved to be very accurate, they allow delivering high doses of radiation in one session without affecting healthy cells.
Such an advanced approach is possible due to the Arc therapy, an integrated scanner, 4D tumor visualization, artificial intelligence Therapanzey contouring, and dosimetry carried out by the "Monaco" software.
The cost of the treatment per metastasis varies from 5000 to 7000 euros at the Oncological Center of High Energy in Nice, but if there are more than 5 metastases, the overall price of the treatment is calculated.
Thus, the overall price of the metastases treatment in Nice with the help of radiosurgery may vary from 15000 to 25000 euros.
It is also worth mentioning that the cost of the same treatment in the famous centers in Europe, such as Curie or Gustave Roussy, will be much higher, due to high demand.
However, the treatment approach will be the same as in the other clinics in France.
Leading centers in Europe often conduct knowledge transfer internships for French doctors, which for example, is the case of oncologist-therapist Troussier, who's been working at the Gustave Roussy oncology center for several years and is now conducting his practice at the Center of the High Energy in Nice.
How are the multiple metastases and breast cancer complications being treated?
Leptomeningeal carcinomatosis.
It is in very rare cases, that breast cancer can provoke the spread of metastases in the bone marrow or leptomeningeal carcinomatosis(synonyms: neoplastic meningitis, meningeal metastasis, meningeal carcinomatosis).
In such cases, the advanced generation of targeted therapy is prescribed, which was approved in France at the end of 2018. It can be carried out in conjunction with radiotherapy.
On 27 September 2018 Elli Lilly has announced that the selling of the Verzenios(Abemaciclib) medication was authorized by the European Commission for the treatment of women with metastatic breast cancer with hormone(RH) positive and epidermal growth factor(HER2-) negative receptors in combination with an aromatase inhibitor(IA) or with a fulvestrant as the first-line hormone therapy or for the women who were previously receiving hormone therapy.
For women both before and after menopause, hormone therapy should be combined with a luteostimulin releasing hormone (LH-RH) agonist.
Verzenios is a CDK4 and CDK6 inhibitor that is available in 50, 100, and 150 mg dosage pills.
The recommended dose of Verzenios is 150 mg twice daily when administered in combination with a fulvestrant or an aromatase inhibitor.
Verzenios should be taken continuously as long as the patient has clinical benefits or until unacceptable toxicity sets in.
“Today, authorization to sell Verzenios in Europe is an important step towards providing a new therapeutic treatment option for patients suffering from this difficult treated disease.” says Ann White, senior vice president and president of Lilly Oncology. ”
Verzenios was developed, studied and demonstrated its clinical efficiency in combination with hormone replacement therapy for women with RH HER2- metastatic breast cancer.
This new therapy gives oncologists an additional opportunity to optimize the therapeutic supervision of patients with metastatic breast cancer.
Verzenios sales authorization in Europe is based on efficiency and safety results, demonstrated by the MONARCH 2 and MONARCH 3 clinical studies.
Abemaciclib inhibits the enzymes cyclin-dependent kinase 4 (CDK4) and cyclin-dependent kinase 6 (CDK6).
In estrogen receptor-positive breast cancer cell lines (ER), cyclins D1 and CDK4 and CDK6 are responsible for phosphorylating retinoblastoma protein (Rb), cell cycle progression and cell proliferation.
In vitro continued Amebaciclib exposure inhibited Rb protein phosphorylation and blocked the cell cycle progression from G1 to the S phase. Blocking this pathway prevents cells from progressing to the S phase, thereby inducing apoptosis (cell death).
Preclinical data showed that the daily administration of Abemaciclib reduced tumor size.
Inhibition of CDK4 and CDK6 in healthy cells can cause some side effects, which might be potentially dangerous.
Clinical evidence also proves that abemaciclib crosses the blood-brain barrier.
For patients with advanced cancer, including breast cancer, the concentrations of abemaciclib and its active metabolites (M2 and M20) in the cerebrospinal fluid are comparable to the concentration of free drug in plasma.
If an inadequate response to the treatment is spotted, it is stopped and the molecule is replaced.
The cost of the treatment is 2500 euros per month, it is sold in a pharmacy on the oncologist prescription only.
It should be reminded, that though targeted therapy is effective, yet it is extremely difficult to tolerate, thus foreign oncologist supervision is mandatory!
For more information, please contact Dr.Troussier's assistant
o.romanova@medifrancesolution.com
