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[Therapy of anthracycline-resistant metastatic breast carcinoma]
1Universitäts-Frauenklinik und Poliklinik, Klinikum Universität Ulm.
Abstract:
Treatment of anthracycline-resistant metastatic breast cancer with new antineoplastic agents remains a challenge for the next future. The 5-year survival for this disease is only 15%, and hormonal and chemotherapeutic options remain essentially palliative. New treatment drugs or drug combinations are urgently needed to improve the prospects for patients with metastatic breast cancer, particularly for those with disease characteristics indicating a particularly poor prognosis. Taxanes are promising new drugs and have shown encouraging activity in patients with disease resistant to anthracyclines and in patients with visceral metastases, both with a poor prognosis. Paclitaxel (taxol) is applied with a dose of 175 mg/m2 in a 3 hour infusion and docetaxel (taxotere) with a dose of 100 mg/m2 q 3 weeks. Remission rates are expected between 6-30% for taxol and between 29-48% for docetaxel. Highly active in patients with anthracycline-resistant disease appears to be the vinca-alkaloid vinorelbine too. In patients treated with adriamycin objective remissions between 15-33% can be obtained. The long time known 5-fluorouracil comes to the third place of the effective drugs. Continuous infusion or addition of folic acid increases the intracellular efficacy and results in 5-53% objective remissions. In second-line chemotherapy platin-analogues together with etoposide, vincristine and 5-FU achieve partial or complete remissions between 19-37% for cisplatin containing and 5-12 for carboplatin containing combinations. This may eventually play a role especially if three drug combinations containing paclitaxel, epirubicin and vinorelbine will be used, which are reported to result in 20-33% complete response rates and 66% objective response. The indication for other new drugs like tomudex, topoisomerase-I-inhibitor and gemcitabine for anthracycline-resistant breast cancer remains to be established in multicenter studies.
Insights
New antineoplastic agents like taxanes and vinorelbine show promise for anthracycline-resistant metastatic breast cancer. These drugs offer improved remission rates, providing new hope for patients with poor prognoses.
Area of Science:
- Oncology
- Medical Oncology
- Pharmacology
Background:
- Metastatic breast cancer resistant to anthracyclines presents a significant therapeutic challenge with a poor 5-year survival rate of 15%.
- Current hormonal and chemotherapeutic options offer limited palliative benefits, necessitating novel treatment strategies.
- Patients with poor prognostic indicators require urgent development of new drugs or drug combinations.
Purpose of the Study:
- To review the efficacy of new antineoplastic agents and drug combinations for anthracycline-resistant metastatic breast cancer.
- To evaluate the potential of taxanes, vinorelbine, and other agents in improving treatment outcomes.
- To identify promising therapeutic options for patients with limited treatment alternatives.
Main Methods:
- Review of existing literature on taxanes (paclitaxel, docetaxel), vinorelbine, 5-fluorouracil, platin-analogues, and other emerging agents.
- Analysis of reported remission rates and objective response rates in patients with anthracycline-resistant metastatic breast cancer.
- Comparison of efficacy data for single agents versus combination therapies.
Main Results:
- Paclitaxel demonstrated remission rates of 6-30%, while docetaxel showed 29-48%.
- Vinorelbine achieved objective remissions of 15-33% in patients pre-treated with adriamycin.
- Combination therapies, including platin-analogues with etoposide, vincristine, and 5-FU, yielded response rates of 19-37%.
- Three-drug combinations with paclitaxel, epirubicin, and vinorelbine reported 20-33% complete response rates and 66% objective response.
Conclusions:
- Taxanes and vinorelbine are highly active agents in anthracycline-resistant metastatic breast cancer, offering improved remission rates.
- Combination chemotherapy, particularly with newer agents, shows significant potential for enhancing treatment efficacy.
- Further multicenter studies are needed to establish the role of novel drugs like tomudex, topoisomerase-I-inhibitors, and gemcitabine.