Novel Treatment Approaches for Managing Early-stage Breast Cancer – Maximising Safety and Outcome with Adjuvant Taxane-containing Chemotherapy Regimens

Novel Treatment Approaches for Managing Early-stage Breast Cancer – Maximising Safety and Outcome with Adjuvant Taxane-containing Chemotherapy Regimens

Aziz Zeba
ASIA PACIFIC ONCOLOGY & HAEMATOLOGY - VOLUME 1
Published: April 2009
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Breast cancer is the second most prevalent type of cancer after lung cancer and the fifth most common cause of cancer-related death.1 In 2008, an estimated 182,460 cases of invasive breast cancer (125.3 per 100,000 women) and 40,480 deaths were expected in US.2 In many Asian countries, breast cancer is the most common (or second most common after cancer of the cervix) female malignacy, and the leading cause of cancer-related death.3 Although the incidence of breast cancer in Asian countries is lower than in western countries, there has been an increasing trend and the rise has particularly affected younger women.4,5 Several studies from Asia have reported a lower median age (45–50 years) and advanced disease on presentation in breast cancer patients. In one series of 487 early breast cancer (EBC) patients at a North Indian institute, the median age at presentation was 47 years, with 16% of patients presenting with stage I and 74% with stage II disease.6 Another Indian study reported that 50–70% of new patients present with locally advanced breast cancer (stage III) or metastatic breast cancer (MBC; stage IV) at diagnosis.7 A Korean study analysing data from one centre between 1989 and 2004 reported that there was a continuous increase in the number of patients with breast cancer, with the median age of patients reported to be between 45 and 48 years in different studies.8

The proportion of EBC (stages 0 and I) increased from 34.2% in 1991 to 48.8% in 2003. In Taiwan, the age-adjusted incidence of invasive breast cancer has increased dramatically due to increased life expectancy.9 There may also be a variation in the rate of oestrogen receptor (ER)-positive cancers among different racial groups. The incidence of ER- and progesterone receptor (PR)-positive cancers has been reported to be similar in Japanese and American women,10 whereas a Chinese study indicated that the ER-positive rate, at 54%, was significantly lower than in Caucasian women.11

Adjuvant chemotherapy has had a significant impact on the management of EBC. This therapeutic strategy has been shown to reduce the risk of recurrence post-surgery and cancer mortality in certain subsets of patients with early-stage disease.12 Since these earlier studies with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) and anthracycline-based regimens, the management of EBC has seen impressive progress with the introduction of the taxanes paclitaxel and docetaxel, aromatase inhibitors and, more recently, targeted therapy, which is being evaluated in this setting.

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