Dialogue with Professor Ma Fei: In the new era of chemotherapy, patients with advanced breast cancer usher in both overall survival and quality of life benefits

*Only for medical professionals to read for reference.
In the era of precision treatment, chemotherapy is still the cornerstone of advanced breast cancer treatment! Is there a chemotherapeutic drug that can benefit both patients' overall survival and quality of life? Breast cancer has a high incidence and is also one of the malignant tumors with a good prognosis.

With the prolongation of overall survival (OS), patients will have to bear more physical pain and psychological and social pressure during their survival.
The quality of life of patients with advanced breast cancer still needs to be improved.

The "Healthy China 2030" Planning Outline includes the quality of life of cancer patients into the category of concern, and also draws the public's attention to another pain point of cancer patients in addition to OS.

On the occasion of the event of Cancer Prevention and Treatment Week-"Caring for Patients with Advanced Breast Cancer and the Launching Meeting of Quality of Life Research", the "medical community" specially invited Professor Ma Fei from the Cancer Hospital of the Chinese Academy of Medical Sciences to express opinions on related topics.

Patients with advanced breast cancer can only live long if they live well.
The "Healthy China 2030" Planning Outline[1] proposes that while improving the 5-year survival rate of cancer patients, the quality of life of cancer patients is also worthy of attention.

Regarding the treatment of advanced breast cancer, the "Chinese Guidelines for Clinical Diagnosis and Treatment of Advanced Breast Cancer 2020" [2] pointed out that most advanced breast cancers are difficult to cure, and the purpose of treatment is to control the tumor and relieve symptoms on the basis of ensuring the quality of life of the patient.
, Prolong survival.

The National Comprehensive Cancer Network (NCCN) guidelines [3] also pointed out that the treatment goal of advanced breast cancer is to prolong the patient’s OS and take into account the patient’s quality of life.

Clinically, what is the relationship between the quality of life of breast cancer patients and their prognosis? Professor Ma Fei mentioned two points: 1.
The quality of life affects the compliance of treatment: the decline of the quality of life of patients will have an impact on the willingness of patients to treat and their compliance with medications.

Large samples of foreign data show that patients with poor compliance have a 60% risk of stopping treatment compared with patients with good compliance.

According to the consensus on the management of adverse reactions in China, the treatment process will also bring a variety of short-term and long-term adverse reactions, which will seriously affect the quality of life of patients, which in turn affects the compliance of drug use, leads to dose reduction or discontinuation, and affects the outcome of treatment.
Have an adverse effect.

2.
Quality of life affects survival outcomes: It has been found in a number of clinical studies that patients with high quality of life scores have a longer overall survival time, that is, a good life can lead to a long life.

However, a study comparing the quality of life of patients in China and the United States [4] pointed out that the score of quality of life of Chinese breast cancer patients is still significantly lower than that of the United States.

Therefore, improving the quality of life of patients with advanced breast cancer in China can help increase the 5-year OS rate of advanced breast cancer in China.

Pay attention to the perceivable adverse reactions caused by chemotherapy.
Guard the quality of life of advanced breast cancer patients.
The quality of life of advanced breast cancer patients is affected by the patient’s physiological factors, psychological factors, and social factors.
Among them, because of the impact of disease progression and treatment on the patient’s normal life ability, usually can not avoid.

The symptoms that patients can perceive autonomously caused by drug treatment are called "perceivable adverse reactions.
" Such adverse reactions should be paid special attention to clinically.

 Professor Ma Fei introduced that chemotherapy is the cornerstone of the treatment of advanced breast cancer, but the adverse effects of chemotherapy are the main factors affecting the quality of life of patients.

Chemotherapy usually causes two types of adverse reactions, namely hematological toxicity and "perceivable adverse reactions.
"
Hematological toxicity is usually preventable and controllable, with minimal impact on the quality of life of patients.

The "perceivable adverse reactions" caused by chemotherapy, such as peripheral neuropathy, hand-foot syndrome, nausea and vomiting, are the main reasons that cause the quality of life of patients to decline and affect patients' willingness to treat.

 Clinically, special attention should be paid to the prevention, control and management of "perceivable adverse reactions", and the pursuit of both overall survival and quality of life benefits.

Eribulin opens a new era of chemotherapy.
Both overall survival and quality of life can benefit patients.
Ma Fei said that Chinese clinicians have long lacked a chemotherapeutic drug that can balance the overall survival and quality of life of patients.
The listing and popularization may gradually meet this clinical need that needs to be solved. Eribulin is a new-generation chemotherapeutic drug.
Its mechanism of action not only inhibits the extension of microtubule ends, but also improves the activity of sequential anti-tumor drugs by improving tumor blood perfusion, and at the same time reverses tumor cells from epithelial to interstitial Type transformation, delay the occurrence of new metastatic lesions.

Eribulin is an important chemotherapy standard for patients with advanced breast cancer after anthracycline and yew.

The EMBARCE study [5] confirmed that eribulin can significantly prolong the median OS by 2.
5 months (13.
1 vs 10.
6 months), reduce the risk of death by 19%, and break the anthracycline violet compared to TPC (a treatment plan chosen by the doctor).
The stalemate that Shanhou chemotherapy drugs do not benefit from OS.

 RU011201I [6] confirmed that compared with paclitaxel, eribulin has the same benefit in OS and progression-free survival (PFS) of advanced breast cancer, but has less effect on neurotoxicity interference and vomiting interference, and can be perceived badly.
There are fewer reactions, which can guarantee the quality of life of patients.

It was further verified in a Japanese real-world study that eribulin achieved significant benefits compared with paclitaxel OS, with a median OS of 22.
3 months, which reduced the risk of death by 32% compared with single-agent paclitaxel.

At the same time, in terms of the incidence of perceivable serious adverse reactions, the incidence of neurotoxicity, joint pain, fatigue, etc.
is lower, which guarantees the quality of life of patients.

 The 301 study [7-9] confirmed that compared with capecitabine, eribulin can significantly prolong the OS of the HER2- population by 2.
4 months and in the TNBC population by 5 months.

At the same time, the eribulin group had a lower proportion of hand-foot syndrome (0.
2% vs 45.
1%), which can guarantee the quality of life of patients.

The 304 study [10] confirmed that compared with vinorelbine, eribulin achieved significant benefits in both PFS and objective remission rate (ORR, 30.
7% vs 16.
9%, P<0.
0001). Aiming at the common neurotoxic side effects of vinorelbine, the neurotoxicity of eribulin was significantly lower than that of vinorelbine (time without neurological symptoms: 35.
3 vs 34.
6 weeks, P=0.
0462; incidence of peripheral autonomic neuropathy: 76.
4% vs 71 %, P = 0.
008), which can guarantee the quality of life of patients.

In the new era of chemotherapy, Eribulin may become a new standard.
Professor Ma Fei said that in the large-scale phase III clinical study of Eribulin, patients with neurotoxicity, weakness, fatigue, diarrhea, nausea and vomiting, etc.
could perceive an insufficient incidence of serious adverse reactions.
9% are chemotherapeutics that can take into account the quality of life of patients.

Randomized controlled studies (RCT) and real-world studies (RWS) have confirmed that eribulin can significantly prolong the OS of patients with advanced breast cancer.
At the same time, patients can perceive a low incidence of adverse reactions, which can maximize the quality of life of patients.

For patients with metastatic breast cancer (MBC), Eribulin may have become the new standard for advanced chemotherapy in the post-yew era! Expert profile Professor Ma Fei is the chief physician, professor, and doctoral supervisor.

Director of Internal Medicine Treatment Center of National Cancer Center/Tumor Hospital of Chinese Academy of Medical Sciences.

Part-time: Secretary-General of the National Anti-tumor Drug Clinical Application Monitoring Committee, Deputy Chairman of the National Cancer Center Breast Cancer Specialty Committee, Secretary-General of the National Cancer Center Breast Cancer Screening and Early Diagnosis and Treatment Standardization Committee, Healthy China Action Advancement Committee warehousing expert, deputy chairman of the Chinese Pharmacist Association Oncology Specialist Pharmacist Branch, deputy chairman of the Chinese Anti-Cancer Association Integrated Tumor and Cardiology Branch, deputy chairman of the Chinese Anti-Cancer Association Multi-primary and Unidentified Primary Tumor Specialized Committee, China Anti-Cancer Association Secretary-General of the Oncology Drug Clinical Research Committee of the Cancer Society, Deputy Chairman of the National Women’s Ovarian Protection and Anti-aging Promotion Engineering Committee, Director General of the Chinese Society of Gerontology and Geriatrics Geriatric Oncology Branch, Deputy Chairman of the Beijing Society for Breast Disease Prevention and Treatment , Beijing Tumor Treatment Quality Control and Improvement Center Tumor Chemotherapy Quality Control Committee Chairperson, etc.

Won the second prize of the National Science and Technology Progress Award, and honorary titles such as the "Top Ten Outstanding Young Doctors in the Capital" and the "China Young Tumor Scientist Award".

References: [1] "Healthy China 2030" planning outline [2] Chinese clinical diagnosis and treatment guidelines for advanced breast cancer 2020 [3] 2021 NCCN breast cancer guidelines V3 version [4] You J, Wang C, Yeung NCY, Lu Q.
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[8] Twelves C, Awada A, Cortes J, et al.
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[9]Pivot X, et al.
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[ 10]Yuan P, Hu X, Sun T, et al.
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