Breast cancer chemotherapy, chemotherapy in the treatment of breast cancer plays an important role, especially as there have been new and effective anti-cancer drugs available, cell kinetics, pharmacokinetics and clinical pharmacology of the continuous development of chemical treatment with a large range of application, efficacy also improved. Current chemotherapy for solid tumors in breast cancer as the most effective of the tumors.
1. Single-drug therapy for breast cancer is currently more effective anti-cancer drug 5 – fluorouracil Well Nick (5-FU), cyclophosphamide cool gel (CTX), doxorubicin. illM), carmustine (BCNU), vinblastine cool plastic (VLB), mitomycin (MMC), methotrexate Ridge (MTX), vincristine (VCR) and vinblastine (VDS), etc. . Doxorubicin is the single most effective drug of drug, the usual dose 40_75mg/m2, every 3_4 weeks 1, in cases not previously used in chemotherapy, efficiency up to 38% _50%; chemotherapy used in the past drugs, there are up to 30% efficiency, the commonly used anticancer agent is 5-FU and methotrexate Ridge, a more efficient. Anhui agent cyclophosphamide cool gum in a more efficient, and the route of administration and methods with little to plant drugs such as vincristine are inefficient.
2. Breast cancer chemotherapy commonly used programs:
CMFVP (cooper) program: P cool plastic ring, a daily 2.5mg / Zhi, Ling oral methotrexate per week, 0.7mg / Zhi, intravenous injection, a total of 8 weeks, 5 – fluorouracil little throat, Zhi 12m per week, intravenous injection, the first 1_4 days after vincristine once a week, weekly 35g / Zhi, a total of 4_5 weeks of prednisone, daily 0.75mg/kg, once a day for 10 days.
3. Early adjuvant chemotherapy for early adjuvant chemotherapy is the treatment of patients with adjuvant chemotherapy as soon as possible. Be diagnosed in the tumor after chemotherapy, the preoperative chemotherapy. Advantages of preoperative chemotherapy: prevent the formation of resistant strains; make the tumor shrink, easy operation; help to understand the sensitivity of tumors to chemotherapy, as a valuable basis for further chemotherapy; to prevent the formation of new metastases stimulate immune activity and so on. Disadvantages of preoperative chemotherapy are: can cause anemia, malnutrition; reduce the number of white blood cells; increase in postoperative wound infection.
CMF in advanced breast cancer programs by ADM and the two alternative courses of chemotherapy after surgery. Methods: ADM75mg/m2 infusion, 3 weeks later with the CMF: CTX 600mg / m2, MTX 40mg / m2, 5 – FU 600mg / m2 intravenously 1, 8 days, every 4-week course of treatment, alternating the 2 treatment.
Wall (1996) and other reports, high-risk patients with preoperative chemotherapy, the use of 5-FU, CTX, E-ADM program, the first two drugs at standard doses, increased doses of the latter drug, proved to be effective and feasible. Methods: 5-FU 500mg/m2, E-ADM 120mg/m2 and CTX500mg/m2 (FEC), every 21 days for treatment. Each course of treatment based on blood cell dose reduction or delay one week, to the effect or deterioration occurs. All 70 patients with lymph node positive patients 60 years of age in the past, not chemotherapy or radiotherapy. 66 cases could be to evaluate the clinical effect, 62 cases were made by histopathological examination, 13 patients achieved clinical CR (20%), resection of the tumor specimens examination, 2 patients did not find malignant tumor cells, and 2 cases of ductal carcinoma in situ . In addition 47 patients with clinical PR, pathological examination was only 1 case hardening, and 4 cases of carcinoma in situ. All patients were CR in 3 cases (5%), 10% had no cancer infiltration. No patient deteriorated during chemotherapy. Moderate bone marrow suppression is the most toxic, and other toxicity was mild, 70 cases 66 cases the whole amount of drug delivery according to plan. Authors believe that the program as a preoperative chemotherapy, patients can have a high tolerance and efficacy. For young high-risk breast cancer, the clinical effective rate was 90%.
Chemotherapy for breast cancer 4. Postoperative adjuvant chemotherapy for breast cancer patients receiving chemotherapy is an effective measure to improve the cure rate and postoperative chemotherapy, the purpose is to eliminate some of subclinical metastatic disease to improve survival, especially the axillary lymph nodes have been transferred cases. The advantages of postoperative chemotherapy: the tumor load is small, doubling time is short, the proliferation rate of large, high sensitivity to anticancer drugs; According to a dynamic principle, a huge tumor removed, easily the smallest tumor burden of drug eradication; tumor load is small, the relative volume of large, adequate blood supply, the occurrence of resistance to fewer opportunities and chemotherapy to cure more likely. Fisher and other have used thiotepa and L-styrene rubber acid nitrogen mustard (L-PAM) after chemotherapy, the method is: Race for the surgery to send 0.4mg/kg, 1,2 days after the 0.2mg / Zhi , and L-PAM after daily 0.5mg / insurance, a total of 5 days, repeated administration every 6 weeks, a total of 2 years through 10 years of follow-up, the recurrence rate of the control group 8% higher than the treatment group. Survival rate of 5%; there are 13 pre-menopausal patients with lymph node metastasis were significantly different, the latter no difference in post-menopausal. Bonadonna CMF chemotherapy application, the dose is as follows: 5-FU 40mg / when methotrexate ra 40mg / when administered after surgery on days 1,8, cyclophosphamide 100mg/m2 day with cool plastic clothes for 14 days, each 4 weeks repeated, shared the 12 courses, through the 8-year follow-up, effect of treatment group than the control group, and mainly on the 13 premenopausal lymph node metastasis, and somewhat less effective in postmenopausal women. Canellos other chemotherapy compared with CMF alone the effect of L-PAM, that the effective combination chemotherapy.
Because doxorubicin single most effective drugs, so someone with Adriamycin as adjuvant treatment program. Chemotherapy are the main CAF, cyclophosphamide cool the plastic 400mg / r coins, intravenous injection on day 1; 5 – FU 400mg / m2, intravenous injection on days 1,8, every 4 weeks repeated administration, a total of 8 courses. Followed up for 6 years, the control group recurrence-free survival was 35% and 66% in the treatment group, postmenopausal control group recurrence-free survival 45%, 62% of the treatment group were significantly different. In addition to more extensive lymph node metastasis, in general, are treated as second-line drugs, mainly because there are certain doxorubicin cardiotoxicity.
Current principles of adjuvant chemotherapy: adjuvant chemotherapy combination chemotherapy efficacy than single agent chemotherapy is better; postoperative adjuvant chemotherapy need to reach a certain dose, the dose of the original plan more than 85%; early postoperative adjuvant chemotherapy should be applied ; treatment period should not be too long; positive postmenopausal women with lymph node metastasis, in addition to high-risk relapse factors, in general, no need to use adjuvant chemotherapy; premenopausal lymph node negative patients, relapse risk factors, if any adjuvant chemotherapy should be applied; lymph node positive, hormone by body-positive adjuvant chemotherapy should be used. Hormone receptor-positive may use tamoxifen treatment.
5. Department of combination chemotherapy of advanced breast chemotherapy regimens currently used are CMFVP, CMF, CMFP so, doxorubicin is a single drug in the most efficient, and its use in combination chemotherapy has improved efficiency, combined with doxorubicin chemotherapy on The program has AV, CA, CAT, etc..
Common second-line chemotherapy regimens in breast cancer with CEF, OCF. Combination chemotherapy in advanced breast cancer have about 30% -80% efficiency, can prolong survival. Complete remission with a median survival of up to 2 years. Chemotherapy patients should
have: general condition is still good, Yuan, heart, liver, kidney and other major organ damage; element was bone marrow suppression, more than 80% of hemoglobin, WBC 400X 109 / L or more, platelet 50X109 / L or more. Pin Zhang et al (1995) reported, using JAC (JM-8, ADM, CTX) treatment of advanced breast cancer in 27 cases. JM 8300mg /, the intravenous infusion, day 1, or 150mg/m2, intravenous infusion, the first 1,2 days, ADM 40mg / when the infusion, the third day, CTX 500mg / when the infusion, the first 3,10 days, every 4 weeks for a course of treatment. The total effective rate was 63%, including CR of 18%, median remission 9 months, median survival of 17 months. Of soft tissue metastasis rate was 61%, lung metastasis was 3 / 5, liver metastasis was 3 / 3, pleural metastasis 4 / 4, bone 1 / 10. Effective rate of initial treatment were 72%, re-treated by 4 / 9, this program gastrointestinal response to light, found no renal toxicity.
Conzcn et al (1996) reported 46 patients with ADM had previously received adjuvant chemotherapy in the treatment of metastatic and advanced breast cancer patients, with the TEMP program: TAM (Tamoxifen) 10mg, 2 times a day orally for 28 days ; VP-16100mg/m2, intravenous infusion, the first 1-3 days, MXT (Mi Tuoen stuffed) 10mg /, the intravenous infusion, day 1, CDDP 30mg / when the infusion, the first 1,2 days, every 4 1 week course of treatment, at least one course of treatment and toxicity were evaluated. Results: 37 patients with internal organs and (or) soft tissue lesions in the effective transfer rate of 41%.
Breast cancer chemotherapy, the program had received adjuvant chemotherapy were ADM total effective rate was 58%, 5 cases with bone metastasis were subjective pain symptoms and increase bone scan element. Pan nearly 59% of patients, N leukopenia, 1 patient died of sepsis. The logic of revelation and the effect of ER (stimulating hormone receptor) status and the presence of visceral metastasis has nothing to do. That the use of ADM TEMP after adjuvant chemotherapy for malignant progression, ER (j) or (a) of the patients have shown effective and ADM after adjuvant chemotherapy in patients with metastatic breast cancer development to their experience or less than 12 months . TEMP Bibi are determined to study more efficient, although the mechanism remains to be clarified, the results suggest that TAM in breast cancer with VP-16/CDDP possible synergies.