Antibody therapy for breast cancer

Not every breast cancer therapy has to be severe side effects that many fear. For patients whose tumours have certain characteristics, antibody therapy has opened up new possibilities: a targeted treatment that precisely attacks cancer cells and largely spares healthy cells - often with significantly less impact than chemotherapy alone.

At the Brustzentrum am Englischen Garten, we first find out whether your tumour responds to this modern form of therapy. What are its characteristics? Which target structures are present? If antibody therapy is an option for you, we now have Highly effective medication We have a wide range of treatments available - from tried-and-tested active substances such as trastuzumab to the latest antibody-drug conjugates. Together we will find the treatment that best suits your individual situation.

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What are the advantages of antibody therapy?

Targeted precision medicine - Their therapy targets cancer cells with specific characteristics, healthy cells are largely spared

Better quality of life during treatment - In contrast to chemotherapy alone, antibody-only therapy usually spares you stressful side effects such as hair loss or severe nausea

Proven efficacy in HER2-positive breast cancer - Antibody therapy has significantly improved survival rates for this type of tumour and considerably reduced the risk of recurrence

First test, then treat - We precisely analyse whether your tumour will respond to antibody therapies before we start treatment - for maximum treatment safety

Treatment that suits your life - We carry out most infusions on an outpatient basis, so you can go home in the evening and do not have to interrupt your everyday life completely

Your safety is our priority - Regular cardiac function checks and close monitoring by specialised oncologists accompany your entire therapy

Optimal therapy combinations - We combine antibody therapies according to current scientific standards with other treatments for the best possible results

What is antibody therapy?

Antibody therapy is a modern form of treatment for breast cancer that specifically targets certain characteristics of cancer cells. Unlike chemotherapy, which attacks all rapidly dividing cells in the body, antibody therapy can differentiate between healthy cells and cancer cells.

Antibodies are protein molecules that our body naturally produces to fight pathogens such as viruses or bacteria. They are part of our immune system and can recognise and mark foreign or harmful structures. We use artificially produced antibodies that are specifically designed to recognise and bind to certain structures on the surface of cancer cells.

These artificial antibodies are developed in the laboratory so that they precisely match certain target structures (so-called antigens) on the cancer cells - similar to a key that only fits into a certain lock. This enables highly targeted treatment that largely spares healthy cells.

How does antibody therapy for breast cancer work?

At our certified breast centre at the Englischer Garten in Munich, we use antibody therapy, which acts against breast cancer cells in various ways:

Blocking of growth signals

The surface of breast cancer cells sometimes contains an increased number of certain receptors that promote cell growth. The best known of these receptors in breast cancer is the HER2 receptor (Human Epidermal Growth Factor Receptor 2). The HER2 receptor is a protein on the surface of cells that promotes the growth of tumour cells in certain types of cancer, such as HER2-positive breast cancer.

When natural growth factors bind to these receptors, they send signals inside the cell that stimulate growth and division. The therapeutic antibodies can bind to these receptors and block them so that growth signals can no longer be received. This is comparable to a plug blocking a socket so that electricity can no longer flow.

Activation of the immune system

The antibodies bound to the cancer cells can help the body's own immune system to recognise and attack the cancer cells. They mark the cancer cells, so to speak, so that the body's defence cells can identify them as foreign or harmful and fight them in a targeted manner.

Transport of active ingredients

Some antibodies are linked to a cell-destroying agent. These are known as antibody-drug conjugates (ADCs). They function like a „Trojan horse“: the antibody binds to the cancer cell and is then absorbed into the cell together with the active substance. Inside the cell, the active substance is released and destroys the cell from the inside out.

This approach makes it possible to deliver highly effective cytotoxins directly to the cancer cells without damaging healthy cells. This means that active substances can be used that would be too toxic for systemic chemotherapy.

Who is antibody therapy suitable for?

We carefully check which patients can benefit from antibody therapy. This treatment is not suitable for every patient. Whether it makes sense depends on the characteristics of the tumour. The so-called HER2 status is particularly important:

HER2-positive breast cancer

About 15 to 20 per cent of all breast cancers are „HER2-positive“. This means that the HER2 receptor is present on the cell surface in excessive quantities (overexpression). This excessive number of HER2 receptors causes the cancer cells to grow and divide particularly quickly.

Antibody therapy is an important treatment option for patients with HER2-positive breast cancer, as it can specifically block these HER2 receptors. HER2-positive breast cancer used to be considered particularly aggressive with an unfavourable prognosis. However, since the introduction of anti-HER2 therapy, the prognosis of these patients has improved significantly.

Triple-negative breast cancer

In triple-negative breast cancer, both the hormone receptors (oestrogen and progesterone receptors) and the HER2 receptor are missing. This form of breast cancer has long been considered difficult to treat, as neither hormone therapy nor anti-HER2 therapy are effective.

Antibody-drug conjugates are now also available for some patients with triple-negative breast cancer. These bind to other structures on the surface of the cancer cells and thus deliver a cell-destroying agent directly to the tumour cells.

Hormone receptor-positive breast cancer

In advanced hormone receptor-positive, HER2-negative breast cancer, antibodies are used that inhibit the formation of new blood vessels (anti-angiogenesis) or that target specific signalling pathways in the cell.

Determination of suitability for antibody therapy

Prior to antibody therapy, the tumour tissue is examined in the laboratory to determine whether the corresponding target structures are present. Two different test methods are usually used for HER2 status:

• Immunohistochemistry (IHC): Measures the amount of HER2 protein on the cell surface
• Fluorescence in situ hybridisation (FISH): examines whether too many copies of the HER2 gene are present

Anti-HER2 therapy only makes sense if these tests are positive.

What types of antibody therapies are there?

Various types of antibodies are used in the treatment of breast cancer at the Breast Centre am Englischen Garten:

Simple monoclonal antibodies

These antibodies bind to certain structures on the cancer cell and block them. The most important representatives that we use are

• Trastuzumab (trade name Herceptin®): The first approved anti-HER2 antibody that binds to the HER2 receptor and inhibits its activity. It is used for both early and advanced HER2-positive breast cancer.
• Pertuzumab (trade name Perjeta®): Binds to a different site on the HER2 receptor than trastuzumab and prevents pair formation (dimerisation) with other HER receptors. It is often used in combination with trastuzumab, as both antibodies complement each other in their effect.

Antibody drug conjugates (ADC)

These antibodies are linked to a cell-destroying agent. Important examples that are used in the Breast Centre at the English Garden are

• Trastuzumab emtansine (T-DM1) (trade name Kadcyla®): Consists of trastuzumab linked to the cytotoxin emtansine. The antibody delivers the cytotoxin specifically to the HER2-positive cancer cells.
• Trastuzumab deruxtecan (trade name Enhertu®): A newer ADC for HER2-positive breast cancer that may also be effective at lower HER2 levels.
• Sacituzumab Govitecan (trade name Trodelvy®): Targets the Trop-2 protein, which is found on many triple-negative breast cancer cells, and transports the cytotoxin SN-38 into the cells.

Antibodies against other target structures

• Bevacizumab: Targets the vascular growth factor VEGF and thus inhibits the formation of new blood vessels that supply the tumour.
• Checkpoint inhibitors such as pembrolizumab or atezolizumab: These antibodies block certain brakes of the immune system (so-called checkpoints) and help the immune system to recognise and attack cancer cells.

How is antibody therapy administered?

Most antibody therapies are administered as an infusion into the vein. The procedure typically looks like this:

• Preparation: Before the first treatment, medication is often given to prevent possible reactions to the infusion (such as fever or chills).
• Infusion: The infusion itself takes between 30 minutes and several hours, depending on the medication. The first infusion is often administered more slowly and takes longer to minimise the risk of infusion reactions.
• Follow-up observation: After the infusion, the patient remains on site for some time for observation, especially during the first therapy.

The frequency and duration of treatments vary depending on the medication and treatment plan. Treatment usually takes place on an outpatient basis, hospitalisation is not necessary.

How long does antibody therapy take?

The duration of antibody therapy depends on the stage of the disease and the treatment goal:

For early breast cancer (adjuvant therapy)

Treatment with trastuzumab after surgery (adjuvant therapy) usually lasts one year. Studies have shown that this duration of treatment can significantly reduce the risk of relapse. Shorter treatment periods (e.g. six months) may also be sufficient in certain situations, particularly in patients with a low risk of relapse.

If the risk is higher, pertuzumab can also be given in addition to trastuzumab, also for one year.

For advanced or metastasised breast cancer

In the case of cancer that has already spread to other organs (metastases), antibody therapy is often continued for as long as it is effective and no unacceptable side effects occur. This can be several years.

If a therapy is no longer effective, it is often possible to switch to another antibody therapy. Today, there are several lines of treatment for HER2-positive metastatic breast cancer.

Before an operation (neoadjuvant therapy)

If antibody therapy is used before surgery to shrink the tumour (neoadjuvant therapy), the treatment lasts typically 3-6 months. After the operation, antibody therapy is often continued until a total of one year of treatment has been reached.

Difference to chemotherapy

Antibody therapy differs from chemotherapy in several important ways:

Purposefulness

While chemotherapy attacks all rapidly dividing cells (including healthy ones), antibody therapy has a more targeted effect on cancer cells with certain characteristics.

Side effect profile

Antibody therapy generally causes fewer and different side effects than chemotherapy. Typical side effects such as hair loss, severe nausea or a sharp drop in blood values are rare with pure antibody therapy.

Mechanism of action

Chemotherapy directly damages the DNA of the cells or disrupts cell division, while antibodies usually block signalling pathways or activate the immune system.

Combination of both therapies

According to the valid S3 guidelines we also offer combined chemo-antibody therapy at our Breast Centre am Englischen Garten, which has been shown to improve the effectiveness of therapy. Once chemotherapy has been completed, antibody therapy is often continued on its own.

Practical tips for antibody therapy patients

Before the treatment

• Inform yourself well about the planned therapy and ask all the questions that are important to you.
• If necessary, organise support for the day of treatment and afterwards.

During the treatment

• Make sure you get enough rest and eat a healthy diet.
• Drink plenty of water, especially on the day of the infusion.
• Report any side effects or unusual symptoms to your treatment team immediately.
• Regular exercise can help combat fatigue, but talk to your doctor about this beforehand.

Long-term support

• Attend the check-up appointments to monitor your heart function.
• If necessary, seek psychological support or dialogue with other affected people.
• Regular follow-up examinations are important after completion of the therapy.

Your therapy, your path - we accompany you through every phase

Antibody therapy is your chance of effective treatment with a better quality of life. At the Brustzentrum am Englischen Garten, we start with a precise tumour analysis: we test whether you can benefit from this treatment method and which active substance is best for you.

From the first infusion to aftercare, we are at your side. Our team knows you and your history, adapts the therapy flexibly and offers you everything you need - from psycho-oncological support to dialogue with other patients.

Would you like to know whether antibody therapy is an option for you? Arrange your personal consultation now. Our specialists will analyse your tumour characteristics, explain all treatment options to you and work with you to develop a tailor-made treatment plan.

Modern cancer medicine means individualised therapy. Let's find the best way together.

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