Chemotherapy for breast cancer: cold thinking under the fever of the go-ring.

The treatment of breast cancer patients in China is facing a new era of "targeting", but the application of chemotherapy cornerstone drugs still needs to be standardized, and the whole process management of patients should be considered, which can improve the long-term survival benefits. According to the latest cancer statistics released by the National Cancer Center,incidence rate of breast cancer ranks first among Chinese women with malignant tumors, and is still in a rapid rise period, increasing by 3.9% annually.new cases and deaths of breast cancer in China account for 12.2% and 9.6% of the world respectively. It is estimated that the number of breast cancer patients in China will reach 2.5 million by 2021.in recent years, thanks to the improvement of early diagnosis and treatment technology, as well as the development of endocrine and targeted drugs, the prognosis of breast cancer patients has been significantly improved, especially the early patients, with a 5-year survival rate of more than 90%.although the treatment of advanced breast cancer is still difficult, the introduction of innovative drugs and the improvement of treatment methods also bring great hope for patients.on June 14, at the "10th new perspective Breast Cancer Summit Forum", the medical community had the honor to invite Professor Liu Qiang, Sun Yat Sen Memorial Hospital, Sun Yat sen University to discuss the hottest topic of breast cancer treatment.Professor Liu Qiang: do Chinese patients want to follow the European and American experience in breast cancer chemotherapy? As more and more targeted drugs are put into clinical practice, more and more studies have been conducted on "de anthracycline" for breast cancer, especially for anthracycline drugs with certain cardiac toxicity."for Chinese patients, due to the significant differences in age of onset, basic cardiac condition and life expectancy, we can not blindly follow the European and American patients, we must put the curative effect in front.the so-called cardiotoxicity caused by anthracyclines is very low in the actual clinical practice of Chinese population.so from this point of view, we should pay more attention to the curative effect of patients."Professor Liu Qiang said," because once our patients are completely cured, the average survival time is significantly longer, and the benefits are obviously greater."in the Department of oncology, there is a certain incidence of heart disease. Therefore, the Department of cardiovascular medicine of Sun Yat Sen Memorial Hospital of Sun Yat sen University launched a study on oncocardiology.but through the investigation of the database of thousands of breast cancer patients in our hospital, it is found that the incidence of heart disease in breast cancer patients is actually very low. Why is this? Professor Liu Qiang explained: "first of all, epirubicin, which is commonly used by Chinese patients, is of low toxicity, and its standard dose is far from its toxicity threshold dose.secondly, our patients are young, not as many patients with basic heart diseases in Europe and America, so our incidence is relatively low."Chinese breast cancer patients usually use anthracycline drugs with low cardiac toxicity. Since the 1970s, anthracycline has become a very classic breast cancer chemotherapy drug because of its remarkable curative effect.at present, Chinese breast cancer patients basically do not choose anthracycline drugs with high cardiotoxicity, such as adriamycin (adriamycin is mainly used in the United States), but choose anthracycline drugs with lower cardiac toxicity such as epirubicin or liposome adriamycin.Professor Liu Qiang said that the current clinical dosage of anthracyclines is far below the threshold of cardiotoxicity. "for example, for adjuvant therapy, the cumulative dose of epirubicin in the four courses of EC (epirubicin + cyclophosphamide) regimen is 360 mg / m2, which is not more than 400 mg / m2 at most. If tec (docetaxel + epirubicin + cyclophosphamide) regimen is used, epirubicin 75 mg / m2, 6 times, that is 450 mg / m2, which is far from the cardiotoxicity limit of epirubicin 800-900 mg / m2, so it is generally safe. "in order to better observe the possible effects of cardiotoxicity, Professor Liu Qiang suggested that patients at risk of heart disease should receive echocardiography once every three months to determine left ventricular ejection fraction, and to monitor whether the heart is damaged by ECG and myocardial enzymes. on average, breast cancer patients in China are significantly younger than those in the United States, and those who are completely cured have greater survival benefits. In Europe and the United States, the median age of onset of breast cancer is about 64 years old. According to the life expectancy of 82 years, only a natural life expectancy of less than 20 years is left. however, in China, the median age of onset is about 48 years old, and there are more than 30 years of natural life expectancy under the same life expectancy, so the survival benefits of Chinese breast cancer patients after thorough cure are more prominent. moreover, breast cancer patients in East Asia are younger in age and have fewer underlying heart diseases. Large sample data from Korea and Taiwan show that anthracycline is not a high risk of heart disease. Professor Liu Qiang pointed out that at present, the most therapeutic schemes of "removing anthracycline" in Europe and the United States are equivalent to those containing anthracycline, and studies such as ABC have shown that the efficacy of "removing anthracycline" is not as good as that of the scheme containing anthracycline in patients with medium and high-risk breast cancer. If anthracyclines, which are important enough for curative effect, are abandoned because of concerns about cardiac toxicity of less than 1% on average, then the risk of recurrence in patients with medium and high risk may increase by more than 1%, which is obviously not worth the loss. of course, for older (& gt; 65 years old) patients with heart disease, we can avoid the use of anthracycline without reducing the cure rate of tumor. ten year message of the new perspective Breast Cancer Summit Forum this year is the 10th new perspective Breast Cancer Summit Forum hosted by Pfizer. The theme of the conference is "ten years with the new". Experts participating in the conference shared the achievements of breast cancer prevention and control in the past ten years, and interpreted the trend of cutting-edge diagnosis and treatment strategies, with a view to promoting the academic development and homogenization of diagnosis and treatment in the field of breast cancer treatment, so as to help more breast cancer patients improve High survival benefits, improved quality of life, help to achieve the overall goal of "healthy China 2030". Professor Liu Qiang also sent a message to the conference for the new decade. Let's have a look at it! Professor Liu Qiang, I think "new perspective" is a very successful forum. in fact, I started to participate in "new perspective" since I returned home more than eight years ago, witnessing the annual holding of "new perspective" and the rapid development of China's breast industry over the years. in the past, the specialty of breast cancer in China was not paid much attention to, and the specialization was not good enough. Compared with foreign countries, there was a considerable distance between doctors' treatment concept and knowledge. However, we can see that in the past decade, due to the promotion of these large academic conferences, the treatment level of breast cancer in China is catching up with the advanced level of foreign countries, and the construction of breast specialty in China is getting better and better. therefore, I hope that the "new perspective" will continue to work together to improve the level of diagnosis and treatment of breast cancer in China, so as to bring more advanced and professional treatment to breast cancer patients in China. Prof. Liu Qiang, director of general surgery, director of breast cancer center, director of breast surgery, chief physician, Professor, researcher and doctoral supervisor of Sun Yat sen University Memorial Hospital. graduated from Xiangya Medical College of Central South University with seven-year clinical medicine major, doctor of surgery, School of medicine of National University of Singapore, lecturer of Dana Farber Cancer Center of Harvard University. member of eso-esmo young breast cancer international consensus expert group, member of Kyoto breast cancer consensus expert group of Japan, member of Asian breast cancer cooperation group, standing member of breast cancer Professional Committee of China cancer clinical association, standing member of tumor molecular medicine professional committee of China Anti Cancer Association, member of breast cancer Professional Committee of China Anti Cancer Association, and breast cancer surgery branch of Guangdong Medical Association Head of adenology group. References: [1] fan L, Strasser weippl K, Li JJ, et al. Breast cancer in China. Lancet Oncol. 2014; 15 (7): e279-e289 doi:10.1016/S1470-2045 (13)70567-9