Treatment of advanced breast cancer
Since advanced breast cancer has clear distant metastases, such as metastases to lungs, bones, brain, etc., and has lost the chance of surgery, comprehensive treatment represented by chemotherapy, endocrine therapy, and targeted therapy has become the main salvage treatment measures for advanced breast cancer.
1. Chemotherapy In recent years, chemotherapy combined with biotherapy has increased the effective rate of advanced breast cancer from 20%-40% to 60%-80%. Combined chemotherapy is better than single-drug chemotherapy, multi-cycle chemotherapy is better than single-cycle chemotherapy, and adjuvant chemotherapy containing anthracyclines and paclitaxel shows greater superiority. Doxorubicin + capecitabine (Xeloda) is an effective treatment option for breast cancer that has already received anthracycline or is resistant to anthracycline. If the patient's general condition is not good and cannot tolerate multi-drug combination chemotherapy program, anthracycline, paclitaxel, hirudin, vincristine, gemcitabine, etc. can be used as a salvage chemotherapy drugs for advanced breast cancer.On October 16th, 2007, a new breast cancer treatment drug, Ixabepilone (Ixabepilone) was approved by the U.S. FDA for the marketing of advanced breast cancer patients who are resistant to hirudin and doxorubicin. Ixabepilone is the first Ebemycin-based antitumor drug with a new chemical structure and therefore has stronger antitumor activity. It has a new chemical structure and therefore has stronger anti-tumor activity. At present, the drug has been actively preparing to be marketed in China.
2. Endocrine therapy For hormone receptor-positive patients, endocrine therapy can be used, but it is generally not applied simultaneously with chemotherapy. Tamoxifen (TAM) is a widely used endocrine therapy drug to antagonize estrogen, which can be used in premenopausal and postmenopausal patients, and needs to be taken continuously for 5 years, and the disadvantages of more than 5 years outweigh the benefits. In recent years, a new generation of aromatase inhibitors, anastrozole, letrozole and exemestane, have been introduced into the clinic for postmenopausal patients and are more effective than tamoxifen. For patients who have failed aromatase inhibitor treatment, progestins such as medroxyprogesterone acetate, medroxyprogesterone, or fulvestrant (currently not available in China) can also be used.
3. Targeted therapy Targeted therapy for breast cancer is one of the most active research areas in recent years. Trastuzumab Herceptin is the first targeted therapy drug approved by the FDA for the treatment of HER2 overexpression in metastatic breast cancer, and it can be used for metastatic breast cancer that has already received one or more chemotherapy regimens, or in combination with paclitaxel. metastatic breast cancer that has not received chemotherapy. Lapatinib (LAPATINI) has been shown to be effective in metastatic breast cancer Lapatinib, a reversible tyrosine kinase inhibitor being developed by GlaxoSmithKline, is a new HER2-targeted drug that can be effective in patients who have failed HER2 therapy and has some therapeutic effects in patients with brain metastases. It is believed that as new molecularly targeted drugs continue to come on the market, they will bring more hope to the lives of many patients with advanced breast cancer.
Emphasis on palliative care
Despite the fact that there are many new anti-cancer drugs on the market, there are still some patients who cannot be cured of their tumors even after active treatment. In the face of such a situation, family members and patients tend to go to the extremes of asking doctors to treat them aggressively at all costs or resigning themselves to the fact that since they cannot be cured, any treatment would be futile. In fact, people have overlooked an important treatment tool for advanced tumors - palliative care.
1. Concept and purpose of palliative care The basic concept of palliative care is to provide active and comprehensive medical care to patients with life-threatening cancer; to recognize that life is a process and that death is the end of life; and to advocate neither accelerating nor delaying death. Palliative cancer care is opposed to the abandonment of treatment; to over-treatment; to euthanasia; and to any disrespect for life. The aim of palliative cancer care is to relieve patients' pain, improve the quality of life and prolong patients' lives, so palliative care is a humanized treatment.
2. Treatment of bone metastasis of advanced breast cancer Advanced breast cancer is prone to bone metastasis, which can produce severe pain, and some of them even have pathologic fracture, which seriously affects the quality of life of the patients, therefore, the pain and repair treatment of bone metastasis is very necessary. In the past, the three-step pain drug therapy, simple chemotherapy, local radiotherapy, etc., although can relieve bone pain to a certain extent, but there are certain one-sidedness and limitations, and some side effects are large, which are difficult for some patients to bear. Bisphosphonates (e.g. pamidronate, zoledronic acid) are potent inhibitors of osteoclasts, which can be tightly adsorbed on the surface of hydroxyapatite of bone, inhibit osteoclasts' activity, effectively prevent osteolytic destruction and deterioration caused by tumor, restore blood calcium to normal in patients with hypercalcemia caused by malignant tumors, reduce bone complications in patients with bone metastases, and relieve pain. Patients receiving bisphosphonate therapy should be supplemented with vitamin D and calcium citrate at the same time.
3. Treatment of advanced breast cancer pain In addition to the standard "three-step" analgesic method, there are many other effective means to solve the cancer pain, such as radiotherapy for metastatic bone pain, manipulative analgesia, nerve destruction therapy, radiofrequency hyperthermia, high-energy focused ultrasound, peripheral nerve destruction block, subarachnoid space, nerve destruction block, sclerotherapy, and so on. subarachnoid nerve destructive block, epidural nerve destructive block, abdominal plexus block, and traditional Chinese medicine for pain relief. As for the specific type of pain relief, professional oncologists need to develop a treatment plan, patients should actively cooperate with the treatment.
Strengthening dietary management
Patients with advanced breast cancer should also pay attention to daily dietary management, as good body function and strong immunity can resist the development of cancer and tolerate various kinds of drug treatments. Therefore, it is extremely important for advanced breast cancer patients to improve their immune system and enhance their resistance to tumor. In daily diet, it is advisable to eat seaweed, seaweed and other foods with the function of resolving phlegm, softening and dispersing knots; when chemotherapy for advanced breast cancer is prone to digestive reactions and bone marrow suppression, sugarcane juice, Buddha's hand, fresh fruit juice and so on can be consumed; fatty foods should be reduced, and less fat and spicy foods should be eaten. In addition, you can also rely on the use of Chinese medicine with anti-tumor and spleen and kidney effects.
Preventing over-treatment
Letting patients with advanced cancer live longer and better is the same wish of doctors and patients. However, modern medical technology is not able to meet the wishes of all advanced cancer patients. For advanced cancers with serious conditions, active anti-cancer treatment may not always prolong the survival of patients, and sometimes it may be counterproductive. Excessive anti-cancer treatment, especially traumatic or toxic treatment, not only fails to prolong the survival time of patients, but also shortens the survival time and further reduces the quality of life of patients. Therefore, for patients with advanced cancer, for whom there is a big gap between the reality and the ideal, clinical treatment decision-making is a great challenge for both doctors and patients.