Immunotherapy for breast cancer in Germany
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Breast cancer immunotherapy is a modern treatment method that has demonstrated effectiveness in all stages of oncology. Thanks to the addition of immunotherapy to the usual treatment protocol, doctors in Germany achieve excellent results in the treatment of metastatic and triple-negative breast cancer, as well as relapses of oncology. There are no common schemes: drugs are selected or even manufactured individually, taking into account the characteristics of the tumor in a particular woman. German clinics actively use immunotherapy and, over the past decade, have accumulated vast practical experience in this area. Such an approach can improve the survival rate and life expectancy of women with breast malignancies.
Content
- When is immunotherapy administered for breast cancer?
- What are the types of immunotherapy for breast cancer?
- How is immunotherapy for breast cancer carried out?
- Benefits of immunotherapy for breast cancer
- How can a woman with breast cancer undergo immunotherapy in Germany?
When is immunotherapy administered for breast cancer?
The main tasks of immunotherapy treatment for breast cancer are as follows:
- Stop or slow down the growth of the primary tumor and its metastases
- For unresectable cancer – prevent metastasizing
- For resectable cancer – prevent recurrence after surgery
- Increase the effectiveness of other cancer treatments (e.g., chemotherapy, radiation therapy)
In the early cancer stages, with large resectable tumors, the doctor may prescribe immunotherapy before surgery, in combination with chemotherapy. This helps to reduce the size of the tumor and make the operation easier: for example, to resect the breast instead of removing it completely. After the operation, immunotherapy is continued without chemotherapy; now, it is aimed at relapse prevention.
If doctors do not perform surgery to remove a breast tumor, then immunotherapy is used to control the disease. It inhibits the further tumor growth and spread of metastases throughout the body. This option is used in the advanced cancer stages, with active metastasizing, or if the woman refuses surgical treatment for any reason. In the advanced stages of cancer, immunotherapy is combined with chemotherapy, hormone therapy, and radiation therapy. This is possible due to its excellent tolerability and the absence of severe side effects.
Immunotherapy is not equally effective in all women. Doctors conduct a preliminary examination to determine exactly whether this type of treatment is indicated. The examination includes genetic and molecular tests, such as:
- Assessing PD-L1 expression
- Assessing the tumor mutation burden (TMB)
- Assessing the number of receptors for interferon-gamma
- Identifying dysfunction of the mismatch repair system
- Assessing the level of microsatellite instability
The diagnostic data shows if the tumor is able to hide from the immune system and which type of immunotherapy will lead to the highest treatment success rates.
What are the types of immunotherapy for breast cancer?
Immunotherapy combines drugs that destroy cancer cells by acting on different parts of the immune system. Sometimes these are factory-made drugs; sometimes, these are drugs that are manufactured individually, using the patient's immune cells. In German hospitals, doctors use three main groups of immunotherapeutic drugs, these are:
- Immune checkpoint inhibitors (PD-1/PD-L1 inhibitors, CTLA-4 inhibitors)
- Cancer vaccines
- Adoptive cell therapy
Immune checkpoint inhibitors are drugs that disrupt a tumor’s ability to hide from the attacks of the immune system. Normally, a woman's immunity recognizes and destroys the very first malignant cells in the mammary gland, preventing tumor development. Unfortunately, a tumor can hide signs of malignancy and resemble healthy tissue. This is recognized and removed by immune checkpoint inhibitors. The pharmacological group includes drugs against various tumor molecules: PD-1 or PD-L1 inhibitors and CTLA-4 inhibitors. Before the treatment starts, doctors determine the initial level of PD-1 in tumor cells: to achieve a good result, and it must be high.
Cancer vaccines stimulate natural specific immunity. This is a strictly individual type of treatment; doctors use tumor components and the patient's leukocytes to make a vaccine. In laboratory conditions, leukocytes "get acquainted" with the surface antigens of a breast tumor. Such leukocytes are called dendritic cells, and after being infused into the blood, they become able to find the tumor and metastases. Dendritic cells help all the other immunocompetent cells detect a tumor: some of such cells directly destroy malignant foci, and the others form a long-term immunological memory in order to prevent a relapse.
Adoptive cell therapy is a technologically more complex type of changing a patient's leukocytes. After such a modification, they can successfully find and attack breast cancer foci, regardless of their localization. CAR T-cell therapy involves the genetic modification of white blood cells: a special receptor is added to them and makes them able to bind to tumor cells. Information about the new receptor is fixed in the genome so that it is reproduced in new generations of leukocytes.
Nanotechnology is also being used to fight cancer. Nanoparticles deliver imaging compounds (at the diagnostic stage), phototherapy compounds, or drugs (at the treatment stage) to tumor cells.
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How is immunotherapy for breast cancer carried out?
Immune checkpoint inhibitors (PD-1/PD-L1 inhibitors, CTLA-4 inhibitors) are given by injections. They are dripped through a vein in an outpatient facility under medical supervision. The drug is administered intravenously once every 3-6 weeks, depending on the general therapeutic regimen. Immune checkpoint inhibitors are well tolerated and have only occasional minor side effects (e.g., fatigue, loss of appetite, nausea, diarrhea). It is a suitable option for immunotherapy for breast cancer stage 4.
A cancer vaccine with dendritic cells is administered subcutaneously in a day hospital. The treatment course includes 3 to 5 vaccinations with an interval of several weeks. In addition, a doctor may recommend a cervical cancer vaccine because there is a clear connection between cervical cancer and breast cancer. Human papillomavirus (HPV) infection is a common cause of cervical cancer. Vaccination creates immunity against this virus, reducing the risk of cervical cancer by 70-90%. Prophylactic cervical cancer immunotherapy is given to young women who are not infected with HPV yet (this is usually before the first sexual intercourse).
Adoptive cell therapy requires only a single intervention, which is inpatient treatment. Hospital admission is obligatory, as patients receive high-dose chemotherapy before the infusion of modified CAR T-cells. Chemotherapy temporarily reduces the level of a woman's leukocytes, so the injected modified CAR T-cells multiply more actively and provide stable anti-cancer immunity faster. The laboratory stage of CAR T-cells creation can take up to 3 weeks, so the patient visits the clinic twice: for blood donation and directly for treatment.
Benefits of immunotherapy for breast cancer
In patients with breast cancer, immunotherapy has such benefits:
- Has proven efficacy in stages II-IV of cancer
- Successfully treats the most aggressive forms of breast cancer
- Reduces the risk of breast cancer recurrence after surgery
- Shrinks the tumor before surgery, allowing it to be resectable
- Affects not only the primary tumor but also metastases, even undetected ones
- Effective in triple-negative cancers where many other techniques have failed.
Immunotherapy drugs are easy to use. Unlike chemotherapy, they do not have to be given in long courses, spending weeks in hospital. Most breast cancer immunotherapy medications are given once every 3 to 6 weeks.
| Cancer stage | Response to standard treatment protocol | Response to standard treatment protocol + Immunotherapy |
| Stage 3 | 50% | 70% |
| Stage 4 | 20% | 50% |
How can a woman with breast cancer undergo immunotherapy in Germany?
If the doctors of your clinic do not use immunotherapy in their practice yet, then you can undergo this treatment at the German cancer center. Booking Health will help you do this, even if you have not previously had treatment experience abroad or even traveled abroad. Booking Health is a medical tourism operator that has been organizing treatment of women with breast cancer from 75 countries in the leading German hospitals for over 12 years. On the Booking Health website you can check the average cost of treatment and information about the specialized hospitals.
Booking Health specialists will accompany every stage of your treatment in Germany:
- Choosing a multidisciplinary hospital or a specialized oncology center for immunotherapy
- Communication with the chosen doctor; if necessary, having a distant preliminary consultation
- Elaboration of a preliminary treatment program without repeating existing examinations
- Making a quick appointment
- Control of the clinic services costs, exclusion of additional fees for foreign patients (saving up to 50%)
- Independent control of the medical program at all stages
- Assistance in purchasing and sending medicines to continue outpatient treatment in your native country
- Communication with the clinic after the completion of treatment
- Final control of prices for medical services and return of unspent funds (in case the clinic requested a deposit for cancer treatment)
- Organization of additional examinations or rehabilitation, if necessary
- Top-level service: booking hotels, plane tickets, transfer
- Services of interpreter and written translation
- Support of a personal medical coordinator 24/7
Fill out the "Send a request" form to contact a medical advisor or choose a clinic and treatment program on the website by yourself.
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Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.
Sources:
Frontiers in Bioengineering and Biotechnology
NIH, National Library of Medicine
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The Main Types of Breast Cancer Treatment in Germany