Metastatic HER2 negative breast Cancer requiring chemotherapy treatment
Abstract
The occurrence of metastases marks an evolutionary turning point in the disease. The median survival of patients at this stage is 24 to 36 months, with significant variations as some patients die in a few months when others survive more than 10 years (1, 2). Overall, there has been a small but undeniable improvement in the management of these patients over the last 20 years. Thus, in the retrospective study carried out at Institut Gustave Rousse, centre Léon Bérard and centre Antoine Lacassagne on 724 patients treated for metastatic breast cancer from the beginning between 1987 and 2000, patients treated after 1993 have a Improved median survival of 5 months compared to those treated between 1987 and Fin 1993 (29 months vs. 23). This improvement is the result of the introduction, in the years 90, of third-generation anti-aromatases and new cytotoxic drugs such as taxanes.
State of the scene and evolution
The occurrence of metastases marks an evolutionary turning point in the disease. The
Median survival of patients at this stage is 24 to 36 months, with variations
Important because some patients die in a few months when others
Will survive more than 10 years (1, 2). Overall, there has been a small improvement
But undeniable of the management of these patients over the past 20
Years. Thus, in the retrospective study carried out at the Institut Gustave Rousse,
Centre Léon Bérard and the centre Antoine Lacassagne on 724 patients treated for
Metastatic breast cancer from the beginning between 1987 and 2000, patients treated
After 1993 have an improved median survival of 5 months compared to those treated
Between 1987 and End 1993 (29 months vs. 23). This improvement is the result of the introduction,
In the years 90, third generation anti-aromatases and
New cytotoxic drugs like taxanes.
When the disease is hormonorésistante, the treatment is based on chemotherapy.
A majority of metastatic evolutions occur after chemotherapy
Adjuvant raising the question of a possible chemoresistance to drugs already
Received, Anthracyclines mainly but also taxanes; This question is not resolved.
Countless phase II studies are available that showed the activity of the
Alkylating (cyclophosphamide, Thiotepa, Ifosfamide, Melphalan, mitomycin),
Anthracyclines (Adriamycin, Epirubicin, mitoxantrone), poisons of the spindle
(Vincristine, Vinblastine, Vindesine, Vinorelbine), Taxanes (paclitaxel, docetaxel,
Epothilones), Intercalan agents (fluorouracil, capecitabine, gemcitabine),
Platinum (cisplatin, carboplatin), etoposide (topo-tisomérase inhibitor
II), methotrexate (inhibitor of thymidylate synthetase)...
But relatively few randomized studies allow for recommendations
Reliable therapies.
Metastatic HER2 Breast Cancer
Negative requiring treatment
by chemotherapy
I. Ray-Shiner, T. Bachelot and J. Guastalla The third generation anti-aromatases have made real progress for the
Patients with overexpression of hormonal receptors, an advantage in
Survival has been shown in several randomized studies (3, 4). The progress of the
Chemotherapy have generally been more modest and therefore more difficult to
Highlight in randomized studies (5). It is currently admitted
That an association of type anthracycline-taxane constitutes a reference treatment
For patients with metastatic breast cancer (6, 7).
Nevertheless, it has always been difficult to prove the interest of an association in relation
To another and it has not been shown that in terms of survival an association
was superior to the same drugs administered successively (8-10).
In addition to the taxanes, new "classical" antimitotic drugs, developed
In recent years, have also provided modest benefits in terms of
Survival without progression and global survival (11). During the years 1980-90,
Numerous clinical studies involving an increase in the dose and/or
The intensity of the cytotoxics has been realized, some using autografts
Marrow and haematological resuscitation techniques. Although some
Patients included in these studies have prolonged lives and that survival
Without recidivism is generally encouraging in phase II, randomized studies
Have not shown that such approaches make it possible to improve the survival of
Overall (12-14). Due to the absence of any real superior results
A cytotoxic approach compared to another, a number of authors
Interested in the quality of life of the patients, so as to select
An optimal therapeutic approach in terms of efficacy/toxicity ratio
(15, 16).
It is unlikely that major progress in terms of survival is still
Possible with conventional therapeutic approaches (17, 18). The improvements
Expected through the use of new antimitotic or new associations
are above all a better efficacy/toxicity ratio (19). As in
In the adjuvant situation, significant progress is rather expected on the side of therapeutic
And the selection of patients, the development of the trastuzumab
Act as a "proof of concept" in this field (20). The development
Of Bevacizumab is also encouraging, and it has been found that the most recent
Somewhat less interesting results obtained with this last drug could
Be the result of the lack of selection of patients on biological criteria when
Inclusion in the two published studies (21, 22).
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