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An Overview of Breast Cancer: Understanding Risks, Treatments, and Market Trends

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Breast cancer is a disease characterized by the uncontrolled growth of cells in the breast tissue. It is the second most common cancer type overall, and the most prevalent cancer among women worldwide, with approximately 2.3 million new cases diagnosed each year globally. It is estimated that around 8 mln women currently live with this type of cancer. Despite significant advancements in treatment, breast cancer remains one of the leading cause of cancer-related deaths, accounting for approximately 670,000 deaths globally. Moreover, in countries with lower HDI¹, 1 in 27 women is diagnosed with breast cancer in their lifetime, 1 in 48 women will die from it. At the same time in countries with higher HDI 1 in 12 women will be diagnosed with breast cancer in their lifetime and only 1 in 71 women die of it².

Risk Factors

Half of all breast cancers occur with no specific risk factors other than sex and age. About 99% of breast cancer cases occur in women, and the risk increases with age. Despite of that, some risk factors may be identified, such as:

Genetics: Inherited mutations in genes such as BRCA1 and BRCA2 significantly elevate the risk of developing breast cancer. Women with these mutations have a higher lifetime risk of breast and ovarian cancers.
Lifestyle Factors: Obesity, alcohol consumption, and smoking are notable risk factors. Maintaining a healthy weight, limiting alcohol intake, and avoiding smoking can reduce the risk.
Reproductive History: Factors such as early menstruation (before age 12), late menopause (after age 55), having children later in life, or not having children at all can increase the risk of breast cancer.

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Mortality: The mortality rate of breast cancer varies significantly across different regions. High-income countries generally have lower mortality rates despite higher number of diagnosis due to better access to early detection and advanced treatment options. In contrast, low- and middle-income countries face higher mortality rates due to limited healthcare resources and late-stage diagnosis.

Types of Breast Cancer

Breast cancer can be classified based on where it begins and its behavior. There are various types of breast cancer, depending on aggressiveness, spread and hormone dependency. All of those types require specialized treatment and provide different prognosis for patients.

Ductal Carcinoma In Situ (DCIS): This non-invasive cancer is confined to the ducts of the breast and has not spread to surrounding tissues. It is considered the earliest form of breast cancer and is highly treatable.
Invasive Ductal Carcinoma (IDC): The most common type of breast cancer, IDC begins in the milk ducts and invades nearby breast tissue. It can also spread to other parts of the body.
Invasive Lobular Carcinoma (ILC): This type starts in the lobules (milk-producing glands) and spreads to surrounding tissues. ILC is less common than IDC but can be more challenging to detect on mammograms.
Triple-Negative Breast Cancer: This aggressive form lacks estrogen, progesterone, and HER2 receptors, making it more difficult to treat with hormone therapy or targeted drugs. It is more common in younger women and those with BRCA1 mutations.
Inflammatory Breast Cancer: A rare and aggressive type that blocks lymph vessels in the skin, causing the breast to become red, swollen, and warm. It often progresses rapidly and requires prompt treatment.

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Treatment Options

The treatment of breast cancer depends on the type and stage of the disease, as well as the patient’s overall health and preferences. Common treatment options include:

Targeted Therapy: This treatment focuses on specific molecules involved in cancer growth and progression. Examples include HER2-targeted therapies for HER2-positive breast cancer. Targeted therapy is often supported by hormone therapy as well.³

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Surgery: Surgery is often the first line of treatment and involves removing the tumor from the breast. Types of surgery include lumpectomy (removal of the tumor and a small margin of surrounding tissue) and mastectomy (removal of the entire breast).
Radiation Therapy: This treatment uses high-energy rays to target and kill cancer cells. It is often used after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.
Chemotherapy: Chemotherapy involves using drugs to destroy cancer cells throughout the body. It can be administered before surgery (neoadjuvant) to shrink tumors or after surgery (adjuvant) to eliminate remaining cancer cells. It is also often introduced in case of advanced stages of breast cancer. Chemotherapy often is combined with hormone therapy in specific cases for the best results for patients.
Hormone Therapy: Hormone therapy blocks hormones that fuel certain types of breast cancer, such as estrogen and progesterone. It is commonly used for hormone receptor-positive breast cancers. This type of therapy may be combined with other treatment options such as chemotherapy or targeted therapy.
Immunotherapy: Immunotherapy helps the immune system recognize and attack cancer cells. It is an emerging treatment option for certain types of breast cancer.

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Palbociclib, Ribociclib and Abemaciclib as targeted therapy⁴⁵⁶⁷⁸

Targeted therapy represents a significant advancement in the treatment of breast cancer, focusing on specific molecules involved in cancer growth and progression. Palbociclib, abemaciclib, andribociclib are prime examples of targeted therapies used to treat hormone receptor-positive (HR+), HER2-negative breast cancer. These drugs are CDK4/6inhibitors, which work by blocking cyclin-dependent kinases 4 and 6, proteins that promote cell division. By inhibiting these kinases, palbociclib, abemaciclib, and ribociclib effectively slow down the proliferation of cancer cells. Clinical trials have shown that these drugs, when combined with hormone therapies like letrozole or fulvestrant, significantly improve progression-free survival in patients with advanced breast cancer. This targeted approach not only enhances treatment efficacy but also tends to have a more favorable side effect profile compared to traditional chemotherapy, making it a valuable option in the management of breast cancer.

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Palbociclib:

Usage: Often combined with hormone therapies such as letrozole or fulvestrant.
Efficacy: Clinical trials have shown that palbociclib significantly improves progression-free survival in patients with HR+/HER2- metastatic breast cancer.
Side Effects: Common side effects include neutropenia (low white blood cell count), fatigue, and infections.

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Abemaciclib:

Usage: Can be used continuously and is effective in both metastatic and early breast cancer.
Efficacy: Abemaciclib has demonstrated benefits in extending progression-free survival and overall survival in clinical trials.
Side Effects: Common side effects include diarrhea and fatigue. Abemaciclib shows a lower risk of neutropenia compared to other drugs used in breast cancer (such as palbociclib or ribociclib), allowing for a straightforward regimen and lowering the risk of infections.

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Ribociclib:

Usage: Often used in combination with an aromatase inhibitor like letrozole for the treatment of HR+/HER2- advanced breast cancer. It is also approved for use in early breast cancer at high risk of recurrence.
Efficacy: Ribociclib has shown significant improvements in progression-free survival and overall survival in clinical trials. For instance, the MONALEESA-2 trial demonstrated that ribociclib combined with letrozole significantly extended overall survival in postmenopausal women with HR+/HER2- advanced breast cancer.
Side Effects: Common side effects include neutropenia, liver enzyme abnormalities, and fatigue

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All three drugs—palbociclib, abemaciclib, and ribociclib—have become integral components of breast cancer treatment, offering significant benefits in managing advanced disease and improving patient outcomes.

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Breast cancer drugs market overview

Targeted therapies currently serve as the primary driving force in the breast cancer drugs market. This market is also propelled by several other significant factors, such as the rising incidence of breast cancer, technological advancements, the increasing demand for personalized medicine, government initiatives, and growing healthcare expenditure. In 2022, the global market for breast cancer drugs was valued at approximately $28,8 billion and is anticipated to expand at a compound annual growth rate (CAGR) of 9.9% from 2023 to 2030. The targeted therapy segment held the largest market share of 63.65% in 2022 and is expected to continue its dominance in the coming years.⁹

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Key contributors to this dominance include abemaciclib, palbociclib, and ribociclib. In 2023, palbociclib was the most valuable drug globally, with a market value of
$5.8 billion¹⁰. Abemaciclib, however, emerged as the most dynamic molecule, experiencing a remarkable growth rate of 65% between 2022 and 2023¹¹. Given these market trends, abemaciclib has the potential to become the most valuable drug in the breast cancer market. Its efficacy, favorable side effect profile, and relatively simple regimen support this optimistic outlook.

Additionally, the increasing focus on personalized medicine is likely to further boost the demand for targeted therapies. Personalized medicine tailors treatment to individual patient characteristics, leading to more effective and efficient care. This approach not only improves patient outcomes but also enhances the overall value proposition of targeted therapies in the breast cancer drugs market.

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Summary

In conclusion, breast cancer remains a significant global health issue, particularly for women. Despite the varying risk factors and types of breast cancer, advancements in medical research have led to the development of more effective treatment strategies. Targeted therapies, specifically drugs like palbociclib, abemaciclib, and ribociclib, have shown promising results in improving survival rates in advanced breast cancer cases. The global market for breast cancer drugs, which was valued at $9.26 billion in 2022, is projected to expand further due to a combination of factors such as rising disease incidence, technological advancements, and an increasing focus on personalized medicine. As we move forward, continued research and innovation will be crucial in enhancing breast cancer management and improving patient outcomes globally.

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