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Breast cancer is treated with appropriate mastectomy surgery and topical radiation. However, breast cancer does not end with topical breast treatment, but requires radical systemic treatment to prevent the cancer from spreading through the blood to other organs. Today, we would like to deal with Vergenio, which is a targeted therapy drug among systemic treatments.
Estrogen receptor-positive breast cancer accounts for 60~70% of breast cancers. This is because when estrogen enters the cell membrane and binds to estrogen receptors, it produces various proteins that cancer cells need to survive. Anti-hormonal therapy for breast cancer is based on blocking this pathway.
There are three mechanisms of anti-hormonal treatment for breast cancer.
The first is a drug of mechanism that interferes with estrogen receptors. The well-known tamoxifen and toremifene are two of them. These drugs work by interfering with estrogen receptors and suppressing estrogen itself.
The second is a drug that inhibits the enzyme that produces estrogen. Aromatase is an enzyme that can produce estrogen in the body of postmenopausal women, and it is especially abundant in fat cells. Femarana, Arimidex, and aromacin are among the strains that inhibit these aromatases.
The third has a mechanism of action to break down estrogen receptors. Parslotex belongs to this family.
Breast cancer targeted therapy, on the other hand, is a treatment that inhibits other pathways that activate breast cancer in addition to estrogen. Vergenio, which we are going to introduce today, is one of the drugs in the family that inhibits the CDK 4/6 enzyme, which activates the cell cycle. Vergenio has been shown to be effective in developing a very potent inhibition of the CDK 4/6 enzyme at a low dose and in early as well as metastatic breast cancer.
The risk of breast cancer recurrence is generally determined by the cardinal level. As with cancer in general, the earlier breast cancer is detected, the easier it is to treat and less difficult to cure. However, if the disease reaches the second or third stage, long-term treatment is required.
In addition, a test called KI-67, or multi-gene testing, has recently been used to determine the nature of breast cancer. Ki-67 is a protein that appears when cancer cells divide, and in general, the higher the Ki-67 score, the more actively the cancer cell is dividing. If you have a high cardinal score and a high Ki-67 score, you have a 30% chance of relapse within 5 years, even if you receive chemotherapy and anti-hormone therapy.
Vergenio is a drug that can be of significant help to patients at high risk of recurrence with a high risk of breast cancer and a high Ki-67 score.
First of all, the clinical study of early breast cancer related to Vergenio was conducted on more than 5,600 high-risk patients. Students had to have more than 4 or less lymph nodes that had metastasized and met one of the three conditions (stage 3 or higher, Ki-67 score greater than or equal to 20%, and size greater than or equal to 5 cm) to be eligible for the study. These high-risk patients receive anti-hormonal treatment for 5~10 years after chemotherapy, and the difference was analyzed by providing Vergenio medicine for an additional 2 years.
The results were astonishing. There was an absolute difference of 3.5% between the Vergenio test group and the control group at two years, and by the third year, the risk was reduced by about 31% and the recurrence rate was reduced by about 5%. In particular, if the Ki-67 score was significantly higher, the risk was reduced by about 37% and the recurrence rate was reduced by 7%. This data is still being updated, and it is expected that the gap will continue to widen over time.
Based on these announcements, Vergenio was first approved by the U.S. FDA and was approved as a new breast cancer drug in Korea in November 2022. As of 2023, it is still expensive because it is offered on a non-reimbursed basis, but it may be a good option for high-risk breast cancer patients with a high radius or a high Ki-67 score.
Q. Can breast cancer occur in the early 20s?
Even at a young age, breast cancer can occur, although rare. However, in this case, genes related to breast cancer are the main cause, and 1/2 of the BRCA gene is typical. BRCA genetic testing is reimbursable, and in some cases, you may be able to have surgery to lower your risk. In the context of the BRCA gene, a drug called Lynparza has been approved for treatment.
Q. Can menopausal hormone replacement therapy increase the risk of breast cancer?
People who experience menopausal symptoms may take hormonal medications. If the use of hormonal drugs is prolonged for more than 5 years, estrogen receptor-positive breast cancer may develop. People with a family history of breast cancer should avoid hormone replacement therapy if possible. However, one tip is to start hormone replacement therapy around the age of 55~60 rather than immediately after menopause, which can reduce the risk of breast cancer a little.
Q. Are dense breasts more susceptible to breast cancer?
Some studies have shown that dense breasts themselves are a risk factor for breast cancer, but more importantly, it is difficult to detect lumps during X-ray examinations. In Korea, ultrasound examinations for the purpose of breast cancer screening are provided as a salary, so in the case of dense breasts, you can get an ultrasound diagnosis.
Q. Is it okay to have frequent X-rays to diagnose breast cancer?
In any diagnosis and treatment practice, it is important to weigh the harms and benefits first. Because the benefits of early detection of breast cancer outweigh the risks associated with X-ray screening, it is recommended to have an X-ray for the treatment or management of the disease.
Q. Can hormone-positive stage 0 breast cancer be cured?
Estrogen receptor-positive stage 0 breast cancer is carcinoma in situ (in situ cancer)*, so most breast cancers can be cured with surgical treatment. In the case of younger patients, it is necessary to monitor them regularly, but basically the rate of re-development of the carcinoma in situ itself is almost non-existent.
*Carcinoma in situ: When cancer cells proliferate only in epithelial tissue without infiltrating into the surrounding area.
Q. Can the estrogen content of strawberries or figs affect breast cancer?
Phytoestrogens, which can be consumed in their natural state, such as fruits and beans, are not usually a major concern for breast cancer. Phytoestrogens need to be taken in very large quantities in order to be linked to breast cancer. If you don't eat 1 box of strawberries a day, you can eat them comfortably.
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