THE ROLE OF TAXANES IN BREAST CANCER CHEMOTHERAPY: WHAT’S NEW 15 YEARS AFTER?
Autori:
Davorin Herceg, Damir Vrbanec
Sažetak
Sažetak. U zadnjem desetljeću taksani se dokazuju kao vodeći citostatici u liječenju karcinoma dojke. U prvoj liniji kemoterapije metastatske bolesti taksani se kombiniraju s drugim citostaticima, premda zasad nema dovoljno dokaza, koji bi potvrdili prednost taksanskih kombinacija u usporedbi sa slijedom (sekvencijom) taksana i drugih citostatika. Više je primjera uspješnih kombinacija taksana s drugim citostaticima: antraciklinima, kapecitabinom, gemcitabinom. Zasad nema dovoljno podataka koji bi odredili neku taksansku kombinaciju kao optimalni izbor. Taksani su također temelj adjuvantnog liječenja ranog karcinoma dojke. Dosad su se uglavnom primjenjivali kod bolesnica s pozitivnim limfnim čvorovima pazuha. Rezultati nedavno objavljenih metaanaliza pokazuju da uspjeh adjuvantne kemoterapije temeljene na taksanima ne ovisi o broju pozitivnih limfnih čvorova, niti o estrogenskom receptorskom statusu. Zasad nema dokazane razlike u efikasno¬sti između nekog od taksana. Paklitaksel je više ovisan o načinu primjene, ima bolje rezultate u tjednoj primjeni, dok je za docetaksel uobičajena trotjedna primjena. Ciljana terapija trastuzumabom u kombinaciji s taksanima poboljšava preživljenje kako kod rane tako i kod metastatske bolesti.
Summary
Summary. Taxanes were established as leading drugs in chemotherapy of breast cancer. In the first line chemotherapy of advanced disease taxanes were combined with other cytostatics. Taxane-based combinations in comparison with taxanes in sequential use were observed. There was insufficient evidence to discriminate in favour of taxane-based combinations. In randomized studies several of taxane-based combinations were tested: taxanes with anthracyclines, capecitabine and gemcitabine. There is no evidence data to prefer any taxane combination to another. Taxanes became fundamental in the adjuvant setting of node positive breast cancer patients. The results of recent meta-analysis were not influenced by the number of axillary metastases or by estrogen receptor expression. At this time there is no data to support the superiority of any particular taxane. Paclitaxel is treatment schedule dependent, because its weekly administration setting may result in better treatment outcome. Docetaxel may be more effective if given every 3 weeks rather than weekly. Targeted therapy in combination with taxanes improves survival rate in adjuvant setting as in advanced disease.
