دانلود رایگان مقاله شیمی درمانی دهان و دندان در سرطان سینه پیشرفته

ABSTRACT

Metastatic breast cancer (MBC) is quite sensitive to chemotherapy, with patients often benefiting from multiple lines of treatment. Continuation of chemotherapy until disease progression, if tolerable, prolongs disease control and improves patient outcomes. Compared to combination regimens, sequential single-agent chemotherapy provides similar efficacy and improved tolerability and may represent the preferred option for most patients. Numerous agents are available, but there are few data to advise optimal sequencing. Oral chemotherapeutic agents, including capecitabine and vinorelbine, have demonstrated significant efficacy in patients with MBC. These drugs prolong disease control with good tolerability, especially when used as single agents. In addition, oral chemotherapy reduces the time and cost associated with treatment and usually is preferred by patients if compared with intravenous delivery. Metronomic administration of oral chemotherapy also represents a promising therapeutic approach for select patients with MBC, inhibiting tumor progression through multiple mechanisms of action. Ongoing clinical trials are exploring metronomic regimens as a strategy to prolong disease control with favorable tolerability. Key data on the role for oral chemotherapy in the therapeutic landscape for MBC will be reviewed and accompanied by expert perspectives on important considerations for the integration of oral chemotherapeutic agents into the treatment of patients with MBC.

Conclusions

Balancing efficacy and QoL is essential for patients with MBC [1,2]. Selection of chemotherapy, endocrine therapy, and targeted agents should be based on current treatment recommendations, clinical trial data, careful assessment of patient and disease characteristics, and very importantly, patient preferences. Sequential monotherapy is the preferred choice for the vast majority of patients who require chemotherapy. Optimal strategies for sequencing therapy are currently unknown. Chemotherapy should be continued until disease progression as long as it is well tolerated. Within the landscape of treatment options, increased attention to patient preference and QoL favors the use of oral chemotherapy agents, such as capecitabine and oral vinorelbine [20]. These agents prolong disease control, provide good tolerability, and reduce the time and cost associated with treatment. However, patient education is fundamental to ensuring appropriate safe use of oral chemotherapeutic agents [20,23]. Oral chemotherapy is also a good option for maintenance treatment to prolong disease control. Metronomic chemotherapy provides multiple-targeted action against breast tumor progression [61]. The convenience and low cost of oral chemotherapeutic agents makes them ideal for metronomic dosing strategies [63]. Metronomic chemotherapy approaches, such as cyclophosphamide ± methotrexate, capecitabine, and oral vinorelbine, have demonstrated efficacy and excellent tolerability in phase II trials and can be considered for some patients with advanced disease [19,63]. Results from large, randomized clinical trials are needed to fully understand the optimal role and positioning for metronomic approaches in the management of patients with MBC.