In the HER-2/neu positive (IHC 3 + or FISH positive) metastatic breast cancer patients, used alone trastuzumab response rate of 15% ~ 24%; and other chemical substances used in combination, have synergistic or additive effect, the reaction rate was 41% ~ 56%, with a median survival time (22.1 ~ 26.8) months. The most common side effects are chills and fever, about 40%, the most serious side effect is cardiac toxicity, so that an average of 20% ejection fraction.
In a wide range of clinical applications based on this year’s ASCO annual meeting system, reported on trastuzumab treatment of breast cancer, three large-scale prospective, randomized international multi-center results of clinical trials (HERA, NCCTG N9831 and NSABP B31 trials). Studies have shown that trastuzumab significantly improved disease-free survival in breast cancer patients with chemotherapy more effective than sequential use of the application. According to available information, it is recommended the use of trastuzumab period of one year (follow-up needs to be further confirmed). In the toxic side effects, either with chemotherapy or sequential use, all increase the cardiac toxicity, using the incidence of cardiac toxicity than sequential use. In short, the current evidence-based medicine, evidence to support the trastuzumab for HER-2 positive early breast cancer adjuvant therapy.
Bevacizumab against vascular endothelial growth factor A (VGFR-A) subtype of recombinant human monoclonal antibody (93% and 7% in rats). On local recurrence or metastatic breast cancer Phase â…¢ randomized clinical trial ECOG 2100, the bevacizumab combined with paclitaxel can significantly improve the patient’s progression-free survival and overall survival. But there is still a lack of clinical prediction bevacizumab treatment of the validity of biological markers, and its high cost of treatment, so not recommended as a standard of molecular targeted therapy for breast cancer programs.
Molecular targeted therapy to individual treatment of cancer possible. However, in our choice of treatment at the same time, it should be more cautious and reflection. As the end of 2000 NIH Consensus Conference on adjuvant therapy in breast cancer stated, any unconfirmed adjuvant therapy, including trastuzumab, bisphosphonates and new chemotherapy and biological therapy in use before they must be a rigorous evaluation of prospective trials.
The author believes that the current clinical application of molecular targeted therapy should consider the following points:
â‘ strict choice of treatment target, that is a specific targeted therapy drug-sensitive tumors (such as HER-2 + by the use of trastuzumab);
â‘¡ molecular targeted therapy cancer treatment is not the final choice should be based on evidence-based medical information, a reasonable standard to use;
â‘¢ molecular targeted therapy can not simply limited to a few specific drugs, with the depth of cancer research, some traditional medicines may also be identified as a new targeted drugs;
â‘£ the future direction of cancer treatment may be replaced by multi-targeted drugs, targeted drug combined with chemotherapy combined, truly individualized treatment.
