Kéo Dài Thời Gian Sống Với Hóa Trị Trong Ung Thư Vú Di Căn
Tóm tắt
Sau khi hoàn thành khóa học này, người đọc sẽ có khả năng: Nhận diện các thử nghiệm đã chứng minh lợi ích sống sót với một tác nhân hoặc phác đồ hóa trị hiện đại trong ung thư vú di căn (MBC). Tóm tắt các phát hiện gần đây từ các thử nghiệm ngẫu nhiên cho thấy lợi ích sống sót với các sự kết hợp giữa liệu pháp nhắm mục tiêu – hóa trị trong MBC. Thảo luận về các phát hiện liên quan đến chất lượng cuộc sống và ý nghĩa của chúng trong thực hành lâm sàng.
Truy cập và tham gia bài kiểm tra CME trực tuyến và nhận 1 tín chỉ vào loại 1 AMA PRA tại CME.TheOncologist.com
Ung thư vú di căn (MBC) vẫn chủ yếu là không thể chữa khỏi, và các mục tiêu điều trị bao gồm giảm triệu chứng, trì hoãn tiến triển bệnh và kéo dài thời gian sống tổng thể mà không làm tổn hại đến chất lượng cuộc sống. Các liệu pháp dựa trên anthracycline và taxane truyền thống đã cho thấy hoạt động cao nhất trong MBC. Mặc dù nhiều thử nghiệm lâm sàng ngẫu nhiên đã cho thấy cải thiện tỷ lệ đáp ứng tổng thể, nhưng rất ít thử nghiệm tìm thấy lợi ích sống sót rõ ràng. Tuy nhiên, trong những năm gần đây, đã có một loạt thử nghiệm lâm sàng nhỏ nhưng đang phát triển chứng minh những lợi thế sống sót khiêm tốn nhưng có ý nghĩa trong bệnh di căn. Một đặc điểm chung trong nhiều thử nghiệm này là việc sử dụng taxane, và gần đây hơn là taxane kết hợp với một antimetabolite. Ngoài ra, sự phát triển của các tác nhân sinh học nhắm mục tiêu có hoạt động chống lại MBC, chẳng hạn như trastuzumab và bevacizumab, đã cho thấy tiềm năng lớn trong việc tăng cường hiệu quả hóa trị và tạo ra những cải thiện về sống còn có ý nghĩa. Vai trò của taxanes, antimetabolites, và sinh học trong việc kéo dài thời gian sống ở MBC được thảo luận.
Từ khóa
Tài liệu tham khảo
American Cancer Society, 2005, Cancer Facts and Figures 2005, 9
Surveillance, Epidemiology, and End Results (SEER) Program
Gralow, 2005, Optimizing the treatment of metastatic breast cancer, Breast Cancer Res Treat, 89, S9, 10.1007/s10549-005-0143-z
Blum, 1999, Multicenter phase II study of capecitabine in paclitaxel-refractory metastatic breast cancer, J Clin Oncol, 17, 485, 10.1200/JCO.1999.17.2.485
Blum, 2001, Capecitabine (Xeloda) in 162 patients with paclitaxel-pretreated MBC: updated results and analysis of dose modification, Eur J Cancer, 37, S190a, 10.1016/S0959-8049(01)81185-0
Blum, 2001, Multicenter, phase II study of capecitabine in taxane-pretreated metastatic breast carcinoma patients, Cancer, 92, 1759, 10.1002/1097-0142(20011001)92:7<1759::AID-CNCR1691>3.0.CO;2-A
Reichardt, 2001, Capecitabine: the new standard in metastatic breast cancer failing anthracycline and taxane containing chemotherapy? Mature results of a large multicenter phase II trail, Eur J Cancer, 37, S191a, 10.1016/S0959-8049(01)81191-6
Fumoleau, 2001, Phase II study of capecitabine (Xeloda®) in patients with advanced breast cancer (ABC), previously treated with anthracyclines and taxanes, Breast Cancer Res Treat, 69, 285a
Miles, 2002, Combination versus sequential single-agent therapy in metastatic breast cancer, The Oncologist, 7, 13, 10.1634/theoncologist.2002-0013
Sledge, 2003, Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193), J Clin Oncol, 21, 588, 10.1200/JCO.2003.08.013
Cresta, 2004, A randomized phase II study of combination, alternating and sequential regimens of doxorubicin and docetaxel as first-line chemotherapy for women with metastatic breast cancer, Ann Oncol, 15, 433, 10.1093/annonc/mdh107
Conte, 2004, Concomitant versus sequential administration of epirubicin and paclitaxel as first-line therapy in meta-static breast carcinoma: results for the Gruppo Oncologico Nord Ovest randomized trial, Cancer, 101, 704, 10.1002/cncr.20400
Alba, 2004, Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first-line treatment of metastatic breast cancer: a Spanish Breast Cancer Research Group (GEICAM-9903) phase III study, J Clin Oncol, 22, 2587, 10.1200/JCO.2004.08.125
Slamon, 2001, Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2, N Engl J Med, 344, 783, 10.1056/NEJM200103153441101
Marty, 2005, Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive meta-static breast cancer administered as first-line treatment: the M77001 study group, J Clin Oncol, 23, 4265, 10.1200/JCO.2005.04.173
Miller, 2004, E2100: a randomized phase III trial of paclitaxel versus paclitaxel plus bevacizumab as first-line therapy for locally recurrent or metastatic breast cancer, Presented at the 41st Annual Meeting of the American Society of Clinical Oncology
Greenberg, 1996, Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer, J Clin Oncol, 14, 2197, 10.1200/JCO.1996.14.8.2197
Fossati, 1998, Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women, J Clin Oncol, 16, 3439, 10.1200/JCO.1998.16.10.3439
Pierga, 2001, Response to chemotherapy is a major parameter influencing long-term survival of metastatic breast cancer patients, Ann Oncol, 12, 231, 10.1023/A:1008330527188
Bruzzi, 2005, Objective response to chemotherapy as a potential surrogate end point of survival in metastatic breast cancer patients, J Clin Oncol, 23, 5117, 10.1200/JCO.2005.02.106
Chia, 2003, The impact of new chemotherapeutic and hormonal agents on the survival of women with metastatic breast cancer in a population based cohort, Proc Am Soc Clin Oncol, 22, 6
Nabholtz, 1999, Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with meta-static breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group, J Clin Oncol, 17, 1413, 10.1200/JCO.1999.17.5.1413
Jones, 2005, Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer, J Clin Oncol, 23, 5542, 10.1200/JCO.2005.02.027
O'shaughnessy, 2002, Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pre-treated patients with advanced breast cancer: phase III trial results, J Clin Oncol, 20, 2812, 10.1200/JCO.2002.09.002
Albain, 2004, Global phase III study of gemcitabine plus paclitaxel (T) as frontline therapy for metastatic breast cancer (MBC): first report of overall survival, J Clin Oncol, 22, 5s, 10.1200/jco.2004.22.90140.510
O'shaughnessy, 2003, Gemcitabine plus paclitaxel (GT) versus paclitaxel (T) as first-line treatment for anthracycline pre-treated metastatic breast cancer (MBC): interim results of a global phase III study, Proc Am Soc Clin Oncol, 22, 7
Bishop, 1999, Initial paclitaxel improves outcome compared with CMFP combination chemotherapy as front-line therapy in untreated metastatic breast cancer, J Clin Oncol, 17, 2355, 10.1200/JCO.1999.17.8.2355
Bontenbal, 2003, Phase II study comparing AT to FAC as first line chemotherapy in patients with MBC, Eur J Cancer, 1, S201, 10.1016/S1359-6349(03)90702-6
Jassem, 2001, Doxorubicin and paclitaxel versus fluorouracil, doxorubicin, and cyclophosphamide as first-line therapy for women with metastatic breast cancer: final results of a randomized phase III multicenter trial, J Clin Oncol, 19, 1707, 10.1200/JCO.2001.19.6.1707
Feher, 2005, First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicenter, randomized, phase III study, Ann Oncol, 16, 899, 10.1093/annonc/mdi181
Figgitt, 2000, Docetaxel: an update of its use in advanced breast cancer, Drugs, 59, 621, 10.2165/00003495-200059030-00015
Sjöström, 1999, Docetaxel compared with sequential methotrexate and 5-fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomised phase III study with crossover on progression by the Scandinavian Breast Group, Eur J Cancer, 35, 1194, 10.1016/S0959-8049(99)00122-7
Bonneterre, 2002, Docetaxel vs 5-fluorouracil plus vinorelbine in metastatic breast cancer after anthracycline therapy failure, Br J Cancer, 87, 1210, 10.1038/sj.bjc.6600645
Gradishar, 2005, Superior efficacy of albumin-bound paclitaxel, ABI-007, compared with polyethylated castor oil-based paclitaxel in women with metastatic breast cancer: results of a phase III trial, J Clin Oncol, 23, 10.1200/JCO.2005.04.937
Miles, 2004, Survival benefit with capecitabine/docetaxel versus docetaxel alone: analysis of therapy in a randomized phase III trial, Clin Breast Cancer, 5, 273, 10.3816/CBC.2004.n.030
Moinpour, 2004, Gemcitabine plus paclitaxel (GT) versus paclitaxel (T) as first-line treatment for anthracycline pre-treated metastatic breast cancer (MBC): quality of life (QoL) and pain palliation results from the global phase III study, J Clin Oncol, 2222, 621, 10.1200/jco.2004.22.90140.621
Chan, 1999, Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer, J Clin Oncol, 8, 2341, 10.1200/JCO.1999.17.8.2341
Paridaens, 2000, Paclitaxel versus doxorubicin as first-line single-agent chemotherapy for metastatic breast cancer: a European Organization for Research and Treatment of Cancer randomized study with cross-over, J Clin Oncol, 18, 724, 10.1200/JCO.2000.18.4.724
Nabholtz, 2003, Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter phase III trial, J Clin Oncol, 21, 968, 10.1200/JCO.2003.04.040
Mackey, 2002, Final results of the phase III randomized trial comparing docetaxel (T) doxorubicin (A) and cyclophosphamide (C) to FAC as first line chemotherapy (CT) for patients (pts) with metastatic breast cancer (MBC), Proc Am Soc Clin Oncol, 21, 35a
Biganzoli, 2002, Doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in metastatic breast cancer: the European Organization for Research and Treatment of Cancer 10961 multicenter phase III trial, J Clin Oncol, 20, 3114, 10.1200/JCO.2002.11.005
Carmichael, 2001, UKCCCR trial of epirubicin and cyclophosphamide (EC) versus epirubicin and Taxol (ET) in the first-line treatment of women with metastatic breast cancer (MBC), Proc Am Soc Clin Oncol, 20, 22
Lück, 2000, Multicentric phase III study in first line treatment of advanced metastatic breast cancer (ABC). Epirubicin/paclitaxel (ET) vs epirubicin/cyclophosphamide (EC). A study of the AGO Breast Cancer Group, Proc Am Soc Clin Oncol, 19, 73a
Pegram, 2004, Rational combinations of trastuzumab with chemotherapeutic drugs used in the treatment of breast cancer, J Natl Cancer Inst, 96, 739, 10.1093/jnci/djh131
Osoba, 2002, Effects on quality of life of combined trastuzumab and chemotherapy in women with metastatic breast cancer, J Clin Oncol, 20, 3106, 10.1200/JCO.2002.03.090
Jain, 2005, Antiangiogenic therapy of cancer: current and emerging concepts, Oncology, 19, 7
Kim, 1993, Inhibition of vascular endothelial growth factor-induced angiogenesis suppresses tumour growth in vivo, Nature, 362, 841, 10.1038/362841a0
Cobleigh, 2003, A phase II dose-escalation trial of bevacizumab in previously treated metastatic breast cancer, Semin Oncol, 30, 117, 10.1053/j.seminoncol.2003.08.013