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The five-year survival rate of breast cancer is increasing year by year
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The five-year survival rate of breast cancer is increasing year by year, and the latest treatment factors are here!
Breast cancer has become the world’s largest cancer, and the five-year survival rate of breast cancer in some countries is as high as 83.2%.
In early January 2021, the World Health Organization’s International Agency for Research on Cancer (IARC) released the latest global cancer burden data for 2020.
Statistics show that in 2020, female breast cancer surpassed lung cancer for the first time, becoming the most common cancer in the world, accounting for approximately 11.7% of new cancer cases.
Among newly diagnosed patients, 1 in 8 is a breast cancer patient. Followed by lung cancer, colorectal cancer, prostate cancer, stomach cancer, liver cancer, cervical cancer, esophageal cancer, thyroid cancer and bladder cancer.
In this “war” against cancer, although various “uncertainties” have brought us all kinds of fears, we still see countless progress in the surviving cracks!
In order to achieve “complete remission” of breast cancer before surgery, what are the key moments worth remembering in the field of neoadjuvant therapy!
▌Early HER2-positive breast cancer neoadjuvant: the cardiotoxic anthracycline regimen is being replaced
In recent years, with the deepening of the research on the pathogenesis of breast cancer, precision targeted therapy of breast cancer has “gradually improved”, gradually expanding from the late stage to the early stage, and from postoperative to preoperative.
At present, the new chemotherapy-targeted combination therapy is making the overall life cycle of breast cancer patients approach the general population, and the “sin” during treatment is becoming smaller and smaller.
Last year, for HER2-positive breast cancer patients, the most noteworthy progress is that new targeted combinations are gradually replacing anthracyclines that cause a serious burden on the heart.
◆ Method 1: Postoperative targeting program can also be used before surgery
For early breast cancer, the standard treatment plan is to use docetaxel (T) + carboplatin (Cb) + trastuzumab (H) adjuvant therapy after surgery, referred to as TCH adjuvant chemotherapy.
In recent years, a multi-center clinical study through up to 10 years of follow-up found that this program is also suitable for preoperative neoadjuvant therapy.
Compared with the traditional “doxorubicin + cyclophosphamide, sequential docetaxel + trastuzumab” regimen (EC-TH), the new regimen can significantly delay recurrence and prolong patient life.
More importantly, as the new plan adjusts the treatment drugs and treatment methods, the burden on the patient’s heart is significantly reduced! Patients with cardiac complications have the opportunity to use neoadjuvant chemotherapy to better integrate into their daily lives.
In 2020, another study published at the ASCO (American Society of Clinical Oncology) meeting once again confirmed the value of the new regimen in preoperative neoadjuvant therapy.
“The study found that the TCH program allows more than half of the patients to “disappear” the tumor (pCR) through preoperative chemotherapy, which further guarantees the effectiveness of the operation. In contrast, the old program can only achieve less than 40% of patients This goal.”
◆ Method 2: “Dual Targets” to the preoperative
Scientists have found a “sister drug” of trastuzumab-Pertuzumab among the many types of HER2 targeted drugs. Rostuzumab can well solve the problem of trastuzumab resistance.
However, in the past, this combination regimen has been almost only used in recent years and has been used for postoperative assistance in patients with advanced or early stages. Is it possible to provide more “guarantees” to patients with early breast cancer through preoperative “neo-adjuvant” methods “What?
In 2020, two high-quality clinical studies have confirmed that ” Dual Target” performs extraordinary preoperative systemic treatment!
“The multi-year follow-up data of the first study found that under the premise of not using anthracyclines, combined with chemotherapy, trastuzumab, and pertuzumab, patients successfully achieved tumor “disappearance” (pCR) after surgery. The odds are significantly improved! The patient’s risk of recurrence and life cycle are also significantly increased.”
We know that trastuzumab itself has a certain degree of cardiotoxicity. This multi-targeted drug treatment method removes the effects of anthracyclines and does not cause more heart disease risks as a whole.
As hormone receptor (HR)-positive, HER2-positive early breast cancer has always been the “darling” in the field of breast cancer treatment, because we have a variety of drugs to choose from. Since endocrine drugs cannot be used simultaneously with chemotherapy, patients with indications for neoadjuvant chemotherapy have to face a “dilemma”-is it better to choose targeted + chemotherapy at the preoperative stage? Or is targeted + endocrine better?
“Another prospective study helped us solve this problem. The results showed that the pCR rate of patients in the dual-target combined chemotherapy group was significantly higher than that of dual-target combined endocrine (56.8%: 23.9%). The former enabled more than half of the patients to achieve tumors. The complete “removal” (pCR) of the latter is only 23%.”
It seems that for hormone-dependent HER2-positive breast cancer, the dual-target combined chemotherapy neoadjuvant therapy has more advantages!
▌Early Luminal breast cancer: preoperative chemotherapy to unlock new options
Generally, triple-negative breast cancer is regarded as a high-risk breast cancer in clinical practice, which means hormone receptor (ER/PR) negative and HER2-negative; correspondingly, if it is HER2-positive breast cancer, multiple HER2-targeting With the blessing of drugs, the patient’s long-term survival data is obviously better.
But in the end, there is another type of breast cancer that is between the “three-negative” and HER2-positive that is not mentioned, that is, the so-called “Luminal” breast cancer that is hormone-receptor-positive and HER2-negative.
In the preoperative stage, the current guideline’s first recommendation is “taxanes + anthracyclines + cyclophosphamide” 21-day chemotherapy. The second choice is neoadjuvant endocrine therapy.
However, the research in this area is not in-depth enough, and oncologists have not given a strong recommendation consensus.
Although there is a lack of better medication options, oncologists have made up their minds on the medication cycle.
Especially after finding out the growth pattern of breast cancer cells, some experts suggested that the interval between 21 days of medication should be shortened to 14 days. This medication mode has been recommended by the CSCO guidelines for postoperative treatment of early HER2-negative patients.
In 2020, the European Society of Medical Oncology (ESMO) meeting announced the 47-month follow-up results of the study. It is believed that this program does not apply to this new adjuvant program for HER2-positive and triple-negative breast cancer, except for Luminal breast cancer. It works well!
▌Early triple-negative breast cancer neoadjuvant: combined immunotherapy allows triple-negative patients to get rid of the “incurable” old situation
Finally, let’s talk about triple-negative breast cancer with everyone. Nearly 20% of early breast cancer patients are triple-negative, namely estrogen receptor (ER) negative, progesterone receptor (PR) negative and HER2 negative.
Whether it is a monoclonal antibody or a variety of small molecule targeted drugs, there are many treatment options for HER2-positive breast cancer, and the effect is very good. But for HER-2 negative patients, especially triple-negative patients, there are almost no drugs to choose from beyond chemotherapy.
The first choice for triple-negative patients before surgery is still chemotherapy. Younger triple-negative patients, especially breast cancer with BRCA mutations, are particularly sensitive to platinum, so platinum-containing regimens can be used before surgery.
In general, in terms of long-term recurrence and metastasis progression, triple-negative tumors and HER2-positive tumors are still different.
While almost no innovative therapies are available, the rise of immunotherapy seems to be throwing light on the “haze” in the hearts of patients with triple-negative breast cancer. Although breast cancer itself is not a highly immunogenic tumor, the triple-negative type seems to be an exception.
“In the earlier KEYNOTE-522 study, it was found that the addition of PD-1 inhibitors to the preoperative treatment system for triple-negative breast cancer can increase the probability of tumor “complete remission” (pCR)! However, the control data of this study is insufficient. Not enough to change the three-yin treatment system.
Another phase III clinical study conducted last year used a classic PD-L1 inhibitor as an immunotherapy drug. The study found that the “immunization + chemotherapy” treatment can make the preoperative response rate (pCR) reach 57.6%! In contrast, single chemotherapy can only achieve 41.1%. “
Fortunately, with the emergence of multiple optimized combinations such as ch
emotherapy, targeted therapy, endocrinology, and immunity, breast cancer, the most common cancer, is being “conquered” bit by bit, and more good treatment methods are being developed. “Be used” step by step.
As a “bumper” for early surgical success and long-term survival of patients, neoadjuvant therapy has always been valued by breast cancer research. In the “difficult and harder” 2020, we will still see a large number of neoadjuvant therapies “turned out.” , Will add more protection to everyone’s future life!
The five-year survival rate of breast cancer is increasing year by year
(source:internet, reference only)