Radiotherapy is a local treatment that uses ionising radiation directed at a specific volume with the aim of destroying tumour cells.

Radiotherapy is one of the treatments of choice for breast cancer. In most cases it is indicated as adjuvant treatment (after surgery) allowing, whenever possible, conservative surgery but with control of the disease equal to that of mastectomy.

Chemotherapy is a treatment in which drugs are given that destroy rapidly growing cells, such as tumour cells.
 

Chemotherapy may be given as the first treatment option when the tumour is large in size, to reduce it before surgery or radiotherapy.

In advanced tumours, when cancer has spread to other parts of the body, it can be given to control the spread and reduce possible symptoms.

In triple-negative patients it is one of the treatments of choice since there are no receptors for targeted or hormonal drugs.
 

Hormone therapies are recommended in tumours that have hormonal receptors, luminal tumours. These therapies work by blocking hormone receptors and preventing cancer cells from reproducing and growing.
 
Hormone therapies may include:
 

• Drugs that prevent hormones from sticking to tumour cells.
• Aromatase inhibitors, drugs that prevent oestrogen production after the menopause.
• Surgery or drugs that prevent hormone production.

Targeted therapies are specific drugs targeted at a specific type of mutation, attacking only this abnormality whilst respecting healthy cells.
 
The most common breast cancer subtype, susceptible to targeted therapies, are HER2 positive tumours. These tumours overproduce a protein called the human epidermal growth factor receptor 2 (HER2) which helps cells reproduce and grow.
 
Monoclonal antibodies such as Trastuzumab, Pertuzumab O, T-DM1 specifically target the HER2 receptor.
 
Alternatively tyrosine kinase inhibitors block the signals that tumours need to grow.
 
These drugs combined with chemotherapy or other treatments have demonstrated a clear benefit to survival in recent years.
 

Immunotherapy describes drugs that helps our immune system to fight cancer. Tumour cells produce proteins that cause our immune system to not recognise cancer cells as harmful cells. Immunotherapy works against these proteins by blocking their action and strengthening our immune system to attack the tumour.
 
In patients with triple-negative breast carcinoma, some trials have studied the use of anti-PD1 or anti-PDL-1 drugs. A study using an anti-PD-1 drug in patients who expressed CPS equal to or greater than 10 was shown to be superior to chemotherapy.