Chau T. Dang, MD

The breast cancer expert spoke about the results presented in the trial, noting the benefit seen with longer follow-up.

The anthracyclines doxorubicin (A) and epirubicin (E) are among the most active agents for breast cancer.

E-Updates in the Adjuvant Treatment of Breast Cancer, Volume 2Updates on Chemotherapeutic Options and Targeted Therapies

Strides made in the treatment of metastatic breast cancer (MBC) appear to prolong survival in some settings, but the cost in terms of quality of life (QOL) remains a concern. The previous four E-Updates in this series on metastatic breast cancer have focused on the various treatment options, including chemotherapy, anti-HER2 targeted therapy, antiangiogenic therapy, and hormonal therapy. In this E-Update, we turn to the role of supportive measures in the treatment of cancer, specifically as these measures relate to quality of life. These measures include the use of erythropoiesis-stimulating agents (ESA) and bisphosphonates, management of fatigue and pain, and psychological care.

In general, metastatic breast cancer (MBC) is treated systemically using chemotherapy, hormonal therapy, and newer targeted therapies when appropriate. About 75% of breast cancers test positive for estrogen receptors (ER) and progesterone receptors (PR), and estrogen stimulation of these receptors plays an important role in the proliferation of these tumors.

Breast cancer is the most commonly diagnosed cancer in women and is the second leading cause of cancer-related mortality, after lung cancer. The overall incidence of breast cancer was increasing until recently, but mortality has declined since 1990, presumably due to earlier detection and better treatments.

Breast cancer is the most common noncutaneous malignancy inwomen in industrialized countries. Chemotherapy prolongs survival inpatients with early-stage breast cancer, and maintaining the chemotherapydose intensity is crucial for increasing overall survival. Manypatients are, however, treated with less than the standard dose intensitybecause of neutropenia and its complications. Prophylactic colonystimulatingfactor (CSF) reduces the incidence and duration of neutropenia,facilitating the delivery of the planned chemotherapy doses.Targeting CSF to only at-risk patients is cost-effective, and predictivemodels are being investigated and developed to make it possible forclinicians to identify patients who are at highest risk for neutropeniccomplications. Both conditional risk factors (eg, the depth of the firstcycleabsolute neutrophil count nadir) and unconditional risk factors(eg, patient age, treatment regimen, and pretreatment blood cell counts)are predictors of neutropenic complications in early-stage breast cancer.Colony-stimulating factor targeted toward high-risk patients startingin the first cycle of chemotherapy may make it possible for fulldoses of chemotherapy to be administered, thereby maximizing patientbenefit. Recent studies of dose-dense chemotherapy regimens with CSFsupport in early-stage breast cancer have shown improvements in disease-free and overall survival, with less hematologic toxicity than withconventional therapy. These findings could lead to changes in how earlystagebreast cancer is managed.

Tumorigenesis is a complex process, and understanding the mechanisms behind tumorigenesis is key to identifying effective targeted therapies. Prostaglandins are signaling lipophilic molecules derived from phospholipids that are involved in normal physiologic functions.