BREAST CANCER BASE

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1. Neoadjuvant Chemotherapy
1. A new adjuvant chemotherapy significance : that of neoadjuvant chemotherapy before surgery or radiotherapy induced by the chemotherapy, mainly for patients with IVA, 3-4 cycles of treatment, has the following advantages :

① about 80% of the patients after chemotherapy significantly reduced clinical efficacy 65-90%, clinical 10-30% CR rate and pathological CR rate at 10%, reducing the clinical stage after surgery so more easily, more so-conserving surgery possible in breast cancer> 5cm the patients after chemotherapy about 73% of the tumor can be reduced to-conserving surgery.

② Breast cancer is a systemic disease at an early stage that is possible distance, hematogenous metastasis, surgical treatment has been about more than half of systemic small metastases, neoadjuvant chemotherapy can further enhance the long-term efficacy;

③ under normal circumstances after six cycles of postoperative adjuvant chemotherapy is often blind, may not be measurable lesions to assess the effects of chemotherapy, adjuvant chemotherapy is conducive to choose effective chemotherapy drugs, the early replacement sensitive to the drug.

1. Two new adjuvant chemotherapy in effect : neoadjuvant chemotherapy commonly used program for AC, CAF, usually 3-4 cycles, including anthracycline kind of combination chemotherapy is superior to CMF programs, in particular the Her-2 positive patients is superior. In 1997 a group of 537 cases comparative study results indicate that neoadjuvant chemotherapy and non-chemotherapy group of eight overall survival II 81.4% compared to 67.6%, Phase III of 46.9% compared with 20% disease-free survival rate II 76.3% over 62 .9%, Phase III was 40.6% compared with 13.3%, National studies have suggested a biopsy after chemotherapy in node-negative increased 37%, the negative lymph nodes survival rate has improved significantly.

Another study also confirmed before treatment is axillary lymph node metastasis, neoadjuvant chemotherapy after the lymph node negative five-year survival rate of 87%, and positive lymph nodes is still only 51%, on the basis of this category if combined with paclitaxel, the efficacy of more encouraging. A group of locally advanced or primary tumor> 4 cm in 167 patients with primary breast cancer using docetaxel combination chemotherapy doing new adjuvant treatment, the docetaxel group and the control group with 94% efficiency over 66%, pathological CR 34% to 18%, 3-year survival rate of 97% more than 84%, 3-year disease-free survival rate of 90% compared with 77%. Taxol drug to the advent of new breast cancer adjuvant therapy has opened up a new prospect in the treatment.

1. Three new adjuvant chemotherapy matters to the attention of :
① surgical treatment of patients unwilling to cut biopsy, the use of biopsy, fine needle aspiration biopsy of a certain failure rate of invasive cancer and non-invasive cancer diagnosis is not certain, and also be difficult to reflect the biological characteristics of breast cancer molecular biology, and inspection of the specimens, it recommended using Core needle biopsy to obtain adequate tissue for pathological and biological inspections.
② axillary lymph node metastasis of breast cancer in stages and decisions for the importance of regional basis, neoadjuvant chemotherapy response will be a good change in breast cancer staging and prognostic evaluation.
③ and axillary lymph nodes of patients with unknown neoadjuvant chemotherapy after chemotherapy is difficult to assess the effect of axillary lymph nodes, proposing a more detailed inspection Imaging.
④ Some may surgery indications of breast cancer patients if handled badly or neoadjuvant therapy ineffective, surgery may be delayed timing.

2. Postoperative adjuvant chemotherapy
3. A anthracycline drugs is the best breast cancer treatment at the front line of drugs, mainly Adriamycin (ADM), epirubicin (EPI), pirarubicin (THP) and mitoxantrone (snap) several. ADM as a first-line treatment of a single drug for 35-50% efficiency, after the standard treatment of CAF and CMF programs six consecutive chemotherapy regimen. CAF (CTX AMD 5- FU) in the treatment of metastatic breast cancer (NBC) for the efficient 50-80%, compared with CMF programs to raise 15-20%, the median remission time and median survival than CMF programs to raise the 3-4 months. The MBC is especially visceral metastasis of postmenopausal patients with ADM should be the preferred option. ADM main drawback is dose-limiting toxicity in the heart of lifelong cumulative dose of 500mg/m2 over 300mg/m2 cardiac toxicity will be significantly increased. EPI replaced with ADM for the same effect, and cardiac toxicity, bone marrow suppression and gastrointestinal side effects such as reaction will be significantly reduced and replaced with THP ADM reduce alopecia.

3. 2 paclitaxel become more effective first-line therapy.
① taxane drugs are mainly first-generation and second-generation paclitaxel in both docetaxel, paclitaxel 135-175mg/m2 every three weeks delivery time, the MBC - treatment drug for a 25-35% efficiency, ADM after the failure of the treatment efficiency of 16%, while losses of Taxol after the defeat ADM still use 30% of the efficiency that Taxol between ADM and no cross-resistance. Taxol can be used as the first class treatment, if treatment failure after ADM again use with the program.
② docetaxel (Taxotere) for the treatment of drug 60-100mg/m2 a weekly meeting, a single agent for 40-68% efficiency, is the current single drug is the most efficient drugs, but ADM and taxol treatment failure of the MBC still better results.
③ The current study is more of paclitaxel and other drugs combined, paclitaxel and anthracyclines category may enhance the effectiveness of joint, but cardiac toxicity, bone marrow suppression and gastrointestinal reactions increased significantly. Paclitaxel and platinum, Vinorelbine, such as capecitabine bin drug use not only the joint effect of good but no significant increase of toxicity. Docetaxel and Cisplatin MBC treatment of efficiency as high as 60%, if not for combination chemotherapy in patients up to 70%, docetaxel joint Vinorelbine Anthracycline-treatment and after treatment Taxol in MBC progress has reached 59% efficiency.

3. Bin 3 capecitabine (Xeloda) is an oral treatment Taxol category ADM and the failure of second-line drugs. Capecitabine bin analogues of 5-fluorouracil, and pharmacological activity of 5-FU continuous infusion similar in tumor cells azacytidine phosphorylase (TP) selective changes to anti-cancer activity of 5-FU, as molecular targeted chemotherapy drugs, usage of 1250-2500mg/m2/d two oral, for 2 weeks out of a week, then repeat the treatment, treatment failure in patients with ADM efficiency 36% and the median duration of 9.1 months and the median survival 12.8 months.

3. 4 to Navelbine is another second-line treatment drugs, mainly Navelbine (NVB) and vinorelbine (Vinorelbine) two. Such drugs are the Changchun alkali drug, its cancer-preventing mechanism is tubulin polymerization and induces microtubule depolymerization so stop cell division, because of microtubule axis weaker affinity, it neurotoxicity low, the main side effect is hair loss and hematological toxicity, common weekly dose of a 25-30mg/m2 a total of three weeks time, NVB single drug therapy Anthracycline-type failure and paclitaxel in patients with micro-20-40% efficiency. Recommendations paclitaxel and Herceptin combined.

3. 5 Herceptin treatment of Her-2 overexpression in breast cancer need second-line drugs, a single agent efficiency of 36.2%, and the efficacy of combination chemotherapy was 62%, the conventional usage of the first dose of 4mg/kg, 2mg/kg weekly after, a group of 34 patients Her-2 overexpression of breast cancer patients with Herceptin plus chemotherapy NVB, and the total efficiency of 75%, as first-line treatment of up to 84% efficiency, treatment Anthracycline-losers as 88%, intellectual oh Taxol losers 50% category, but good safety.

3.6 Premetrexed (alimta) as refractory breast cancer three-line treatment, alimta is broad-spectrum anti-folate drug, which inhibit adenylate including synthetic enzyme dihydrofolate reductase, glycerol amide nucleotide methylation enzyme in a variety of folate-dependent enzyme, the first approved for the treatment of pleural mesothelioma . Recently, has been widely used in breast, lung and gastrointestinal cancer treatment, a group of 38 cases of the past used combination chemotherapy and endocrine treatment of patients with MBC alimta The total efficiency is still 28%.

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