With metastatic breast cancer (MBC) treatment is highly challenging and complex, as most patients have lost the partial treatment, drugs are the basic treatment options. The past 20 years, with the breast cancer biological characteristics and molecular markers of in-depth study of the medical profession more and more profound understanding that MBC has a high degree of heterogeneity, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-positive and three negative breast cancer (HR and HER2 were negative) and has a very different treatment strategies. On the other hand, with the combination of anticancer drugs and an increase in the program, MBC-line treatment for all have more choices. Correct understanding of the biological characteristics of MBC in order to make rational use of increasingly rich drug treatment.
MBC treatment goal is to effectively prevent treatment-related complications, based on the delay disease progression, relapse, and prolong survival time, while achieving the mitigation cancer symptoms and quality of life improvements. MBC treatment of the current framework: HER2-positive patients should consider targeted therapy (trastuzumab, lapatinib, etc.); for MBC accounts for the majority of HER2-negative patients, in which no visceral involvement may be the first choice of HR-positive endocrine therapy; while visceral involvement of the HR-positive and three negative breast cancer should be the preferred chemotherapy (Figure 1), in which discussion focused on chemotherapy.
The first-line chemotherapy for MBC, including single-agent treatment and joint programs. Single-drug program is the most widely used taxane drug; Since 2002, a number of clinical studies confirm that taxane based on the joint use of certain chemotherapy drugs (such as capecitabine, gemcitabine and so on) may be further extended survival. Except for a few programs, the current first-line chemotherapy, most of the MBC program to taxane drugs, the future studies mostly targeted therapy with taxane based on the program reflects the taxane first-line chemotherapy in MBC There is no doubt the cornerstone of the status. At this stage in the treatment of taxane-containing MBC’s response rate (RR) of about 50%, single-agent taxane progression-free survival (PFS) and overall survival (OS) at 6 months and 1 year or so, the joint program The PFS and OS were raised to 1 year and 2 years.
In recent years, several clinical studies confirmed that, MBC patients with taxane drug was added based on the anti-angiogenic drug, bevacizumab could be further improved efficacy. ECOG 2100 study, paclitaxel (Taxol) combined bevacizumab, the treatment of MBC’s objective response rate (ORR) can be significantly increased from 13% to 29.9% (P <0.0001), PFS from 6.11 months significantly increased to 11.4 months (P <0.0001). In the 2008 publication of the results of the AVADO study of docetaxel combined different doses of bevacizumab after, PFS improvement of less than 1 month (8.0 pairs of 8.8 or 8.7 months), ORR increased range is limited. These two studies showed that different taxane drug combination bevacizumab, the benefit of a greater magnitude of difference, suggesting that paclitaxel (as opposed to Docetaxel) Joint use of bevacizumab may bring even more survival benefit.
Iscia horse Takashi: anthracycline / taxane-resistant patients a new choice
Anthracycline and taxane drugs in early breast cancer (EBC) auxiliary or neo-adjuvant chemotherapy is being more and more widely, so relapses are already on these two types of drug resistance. The current treatment options for such patients is limited, the urgent need for more effective clinical treatments.
In recent years, access to clinical Epothilone antineoplastic isha long piece of anthracycline / taxane-resistant MBC patients a new choice. The role of drug mechanism of taxane similar, can promote tubulin polymerization and inhibit their depolymerization, so that tumor cells arrested in G2 / M phase followed by apoptosis. Iscia the molecular structure of horse lung, and tubulin binding site and taxane completely different from the drug treatment of β Ⅲ Tubulin overexpression in taxane-resistant breast cancer is still valid, and can not easily be ATP-binding cassette transporter protein ( ABC Transporter) transport out of tumor cells outside. Therefore, iscia long piece for multiple mechanisms of anthracycline / taxane-resistant susceptibility were lower, for after anthracycline and taxane MBC relapse after treatment is still a significant anti-tumor effect.
Phase â…¢ randomized controlled clinical study CA163046 and CA163048 shows that have taken place in anthracycline / taxane-resistant or complex governance of MBC patients with lung + isha horses capecitabine in the treatment, PFS and ORR compared with capecitabine alone can be Drug treatment significantly improved lung confirmed by isha horses can improve the anthracycline / taxane-resistant MBC, or the efficacy of retreatment. Based on the above research data, the U.S. Food and Drug Administration (FDA) has approved isha horses in 2007 combined with capecitabine for the long anthracycline / taxane-resistant MBC treatment.
With anthracycline / taxane adjuvant or neo-adjuvant chemotherapy within 12 months after relapse in patients with first-line treatment options are limited, and most of them with anthracycline and taxane drug resistance, so this in some patients for new treatment options are pressing needs. In 2008 San Antonio Breast Cancer Conference (SABCS) reported on a set analysis summarizes the CA163046 and CA163048 data of the study revealed that Isa horse lung combined with capecitabine in first-line treatment of anthracycline / taxane-assisted, or neo-adjuvant chemotherapy After the rapid recurrence (≤ 1 year) patients, efficacy is superior to capecitabine monotherapy (Figure 2), for such drug-resistant patients with a more effective treatment options.
With the same for the microtubule stabilizing agent taxane similar to Isa horse-lung also has peripheral neuropathy adverse reactions. 2008 SABCS, on a retrospective analysis of a summary of three horse-long treatment of MBC using the isha clinical research data, showing isha horse lung and joint programs, place a single agent in 3 ~ 4-givers the proportion of peripheral neuropathy was 14%, respectively and 20%, and mainly sensory neuropathy, mostly cumulative, its recovery rate (return to baseline, and a degree of disease) was 76% ~ 89%, with a median recovery time of 5 ~ 6 weeks, suggesting that horses Isa Lung re-givers in the incidence of peripheral neuropathy lower short duration, and most can be alleviated or dissipated.
3-negative breast cancer: isha horse show bright prospects for long
3-negative invasive breast cancer have a high and poor prognosis, pathological manifestations were invasive ductal carcinoma. Such there is no standard treatment of breast cancer, chemotherapy is still the main current treatment. 2008 SABCS on a retrospective analysis summarizes the CA163046 and CA163048 study, more than 400 cases of 3-negative breast cancer treatment data, showing isha horse lung combined with capecitabine in the treatment of such MBC in PFS and ORR was significantly better than Card Pei gemcitabine monotherapy group (Figure 3). Security side, 3-negative breast cancer patients with these two studies in general, the isha types of horse-lung combination therapy similar to the incidence of adverse reactions. Therefore, iscia horse lung is expected to become a better 3-negative breast cancer chemotherapy options.
Summary
1 MBC first-line chemotherapy with taxane-based joint anti-angiogenic targeted therapy may further improve the curative effect.
2 and the United docetaxel compared with bevacizumab plus paclitaxel treatment of MBC brings a survival advantage may be greater.
3 iscia horse Lung Treatment of Anthracycline / taxane-resistant patients by the administration can significantly improve the efficacy of its external peripheral neuropathy adverse reaction to a lesser extent and the duration is short, easy to mitigate.
4 iscia long piece first-line treatment of joint programs anthracycline / taxane chemotherapy rapid recurrence after three negative MBC patients and has better curative effect.
