What are the possible side effects?

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Monoclonal antibodies are given intravenously. Since antibodies are proteins, this can sometimes trigger an allergic reaction. However, this reaction is more common to occur in the first dose of treatment. Possible side effects may include: Fever, Chills, Weakness, Headache, Nausea, Vomiting, Diarrhea, Low blood pressure and Rashes.

Compared to chemotherapy drugs, monoclonal antibodies tend to have fewer serious side effects.

What is OLAPARIBE?

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OLAPARIBE is a drug in the PARP inhibitor class, one of the types of “target therapy” in oncology. Conceptually, this type of treatment aims to inhibit specific points that lead to tumor cell growth, generating less effects on normal cells and, consequently, less harmful events. PARP is an enzyme present in every cell in the body. Its function is to promote repair of the damage that occurs in the DNA over time. Through OLAPARIBE it is possible to prevent these repairs from happening in the cancer cell, leading to its death.

OLAPARIBE has the greatest effect on patients who have an inherited genetic mutation called BRCA, which can be passed from parent to offspring. This gene is also responsible for DNA repair in normal cells, and when it is absent or mutated, the patient is more likely to develop some tumors, including breast cancer. The association of BRCA + OLAPARIBE mutation causes multiple DNA defects and consequent death of tumor cells.

OLAPARIBE is approved in Brazil for breast cancer patients with metastases, who are HER2-negative, who have previously been treated with some type of chemotherapy and hormone therapy during the course of the disease, and who have a mutation in the BRCA germline gene (ie, hereditary).

What are bisphosphonates and their use in the treatment of breast cancer?

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Adjuvant bisphosphonates reduce bone recurrence and improve survival in postmenopausal patients with non-metastatic breast cancer. They are indicated in case of bone metastases, but there are studies suggesting that their adjuvant use reduces the risk of disease spread.

The absolute benefit is greatest in patients at higher risk of recurrence, and almost all studies have been performed in patients who also received systemic therapy. Most studies have evaluated Zoledronic acid and data are extremely limited for other bisphosphonates. Although Denosumab reduces fractures, long-term survival data are still needed.

Risk factors for osteonecrosis of the jaw and kidney failure should be evaluated, and any outstanding oral or dental health problems treated before starting treatment.

How to assess therapeutic response?

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Patients undergoing palliative care should be monitored with imaging tests (preferably CT) to assess therapeutic response at disease sites every 6-12 weeks of treatment with chemotherapy or hormone therapy.

In case of stable disease or therapeutic response, a total of 6-8 cycles is recommended depending on the tolerance to the treatment. However, there is no proven data to define the number of chemotherapy cycles to be used. Some authors suggest the maintenance of the treatment, as long as there is benefit, respecting the toxicity, but there are no data to justify the maintenance treatment with an improvement in overall survival.

Patients undergoing hormone therapy should receive treatment until disease progression. Tumor markers are not recommended for response assessment. Patients using previous chemotherapy or hormone therapy should be monitored with clinical examination.

How is the follow-up after treatment?

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Physical examination should be performed every 3 to 6 months for the first three years, every 6 to 12 months for the next 4 and 5 years, and annually thereafter.

For women who have undergone breast-conserving surgery, post-treatment mammography should be obtained one year after the initial mammogram and at least 6 months after completion of radiotherapy.

Patients taking tamoxifen should undergo an annual gynecological exam and complement it with an annual transvaginal ultrasound, if they have a uterus.

Patients using aromatase inhibitors should undergo annual bone densitometry

The use of complete blood count, serum biochemical measurements, bone scintigraphy, chest radiography, abdominal US, CT, MRI, PET-CT or tumor markers is not recommended for routine follow-up in an asymptomatic patient, without specific findings on clinical examination.

Patients with metastatic disease should be followed up with imaging at disease sites every 3-6 months, or as clinically needed or evidence of progression.

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What is the survival rate for breast cancer?

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Survival rates are used by physicians as a standardized way of discussing a patient's prognosis. They cannot predict how long each patient will live, but they can help give a better idea of the prognosis.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after the diagnosis of the disease. Nevertheless, many people live much longer than 5 years and many are cured.

Survival rates are based on past results from a large number of people who have had the disease, but it is not possible to predict what will happen in the specific case of a patient. There are limitations to consider:

5-year survival rates are calculated based on patients treated for at least 5 years. However, recent therapeutic improvements may result in a more favorable prognosis for patients who are now being diagnosed with breast cancer.

The relative 5-year survival rate for women with stage 0 or stage I breast cancer is close to 100%.

For women with stage II breast cancer, the relative 5-year survival rate is 93%.

The relative 5-year survival rate for stage III breast cancer is 72%. But often, women with these breast cancers can be successfully treated.

Breast cancers, which have spread to other organs, are more difficult to treat, and tend to have a worse prognosis. Stage IV or metastatic breast cancers have a relative 5-year survival rate of 22%. Still, there are many treatment options available for women with breast cancer at this stage.

These survival rates are estimates only, they cannot predict what will happen in the specific case of each patient. Only your doctor can tell you if the numbers apply to you.

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