Drug Therapy for Breast Cancer

Yeon Hee Park

doi:10.5124/jkma.2009.52.10.963

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Park: Drug Therapy for Breast Cancer

Focused Issue of This Month

Breast Cancer

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2009; 52(10): 963-974.

Published online: 31 October 2009

DOI: https://doi.org/10.5124/jkma.2009.52.10.963

Drug Therapy for Breast Cancer

Yeon Hee Park, MD

Division of Hematology-Oncology/Department of Medicine, Sungkyunkwan University Scool of Medicine, Korea. yhparkhmo@skku.edu

Abstract

Breast cancer is the second common cancer and the leading cause of cancer deaths in women in Korea. Contrary to public perception, it is a heterogeneous disease with varying morphology, prognosis, and response to therapy. Understanding of the tumor biology results in marked advance in drug therapy proceeding to individualized molecular targeted therapy using predictive biomarkers (hormonal receptor: HR and human epidermal growth factor receptor -2: HER2). This review considers various drug therapeutic options based on biologic background of breast cancer divided into metastatic, neoadjuvant, and adjuvant systemic drug therapies. These are conventional cytotoxic chemotherapy, hormonal therapy, and molecular targeted therapies including trastuzumab, an anti-HER2 monoclonal antibody. In addition, bisphosphonate to improve outcomes of bone metastasis has seen an increased usage in adjuvant and metastatic setting. Microarray based genomic, transcription, and proteomic methods are transforming classification systems and identifying novel targets for the development of new therapeutics. It is important for us to appreciate and embrace the new developments as they will impact on daily clinical practice and require understanding of biomarkers as a tool for the determination of treatment options.

Keywords: Breast cancer, Chemotherapy, Hormone receptor, HER2, Molecular targeted therapy

Figures and Tables

Figure 1

Integration of novel targeted therapies into the systemic treatment of breast cancer.

Table 1

Therapeutic options of metastatic breast cancer according to risk factors

Table 2

Hormonal treatments in advanced breast cancer according to menopausal status

Table 3

Summary of trials comparing chemotherapy plus trastuzumab with chemotherapy alone in patients with metastatic breast cancer

IHC: immunohistochemistry, ORR: overall response rate, OS: overall survival, TTP: time to progression, T: trastuzumab, P: paclitaxel, A: doxorubicin, AC: doxorubicin+cyclophosphamide, D: docetaxel, ORR: overall response rate, TTP: time-to progression, OS: overall survival

Table 4

Choice of treatment modalities in adjuvant systemic therapies

^*tumors express high levels of both steroid hormone receptors in a majority of cells

^†some expression of steroid hormone receptors but at lower levels or lacking either ER or PgR

^‡tumors having no detectable expression of steroid hormone receptors

Table 5

Summary of adjuvant trials containing taxanes

HR: hazard ratio, AC: doxorubicin, cyclophosphamide, T: paclitaxel, FAC: fluorouracil, doxorubicin, cyclophosphamide, DAC: docetaxel doxorubicin cyclophosphamide, E: epirubicin, FEC: fluorouracil epirubicin cyclophosphamide

Table 6

Summary of randomized trials of adjuvant aromatase inhibitors

HR+: hormone receptor-positive, LN+: lymph node-positive, Tam: tamoxifen, DFS: disease-free survival, EFS: event-free survival, PFS: progression-free survival

Table 7

Summary of randomized, phase III trials evaluating adjuvant Trastuzumab in patients with HER2-positive early-stage breast cancer

T: trastuzumab, CTx: chemotherapy, AC: doxorubicin+cyclophosphamide, P: paclitaxel, DCT: docetaxel+carboplatin+ trastuzumab, V/D: vinorelbine or docetaxel, CEF: cyclophosphamide+epirubicin+fluorouracil, FECHR: hazard ratio, DFS: disease-free survival, DFSR: disease free survival rate, OS: overall survival, OSR: overall survival rate

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