乳癌治療的新趨勢

New Trands in the Treatment of Breast Cancer

10.6880/TJON.200912/SP_9.03

林斈府(Hsuen-Fu Lin)；莊岳泉(Yoke-Chun Chung)；吳逸騹(I-Chi Wu)；黃文彥(Wen-Yen Huang)；趙祖怡(Tus-Yi Chao)

乳癌 ； 化學治療 ； 標靶治療 ； breast cancer ； chemotherapy ； target therapy

腫瘤護理雜誌

9卷S期（2009 / 12 / 01）

19 - 35

繁體中文

近年來，乳癌的治療進展迅速，除了手術重建技術的進步之外，搭配乳房保留手術之放射治療技術也有所進展。在手術重建可以考量立即重建及延遲重建，可使用義乳或是自體組織；放射治療雖然目前定位為局部治療之一環而非主要治療，但是放射技術之進步已經可以縮小照射範圍，以減少長期併發症的產生；而化學治療的進展除了將紫杉醇類藥物加入原本以adriamycin為主的處方，成為新一代的標準治療用藥之外，紫杉醇類藥物使用的方法也越來越多樣化，其目的是減少病人的副作用，又能維持療效。針對人類上皮生長因子受體作用之標靶療法，更將早期乳癌手術後病人的存活率大大提高，復發率大幅下降。第二代的人類上皮生長因子受體的標靶藥物雖然目前仍只限用於復發的病患，但是陸續成功的新標靶，如：血管新生因子，也使復發的病人得以增加無病存活期並提升了生活品質。新的藥物不斷地投入對抗乳癌的治療，不論是老藥新用的gemcitabine或是重新使用的fluropyrimidine類藥物，如：capicitabine，也都有不錯的成效。醫師目前面臨的挑戰是如何選擇最恰當的處方與搭配藥物，以達乳癌治療最大的效果，同時亦注重病人治療時的生活品質。

The evolution of treatment for breast cancer has progressed rapidly. Surgical resection is still the mainstay for treatment of breast cancer. Regarding to risk of relapse, breast conserving surgery with adjuvant radiotherapy is compared with modified radical mastectomy. As an experienced breast surgeon, immediate or delayed reconstruction of breast with autologous tissue or use of implants should be well discussed and in conjunction with radiotherapy and chemotherapy. The role of radiotherapy is local control. With the new techniques, long-term complications of heart and mediastinum are lessening. With development of new drugs and different schedules, advances in systemic therapy for breast cancer have improved survival and adverse effects. Taxane based regimen or combination with adriamycin demonstrated a better response rate and survival rate than adriamycin based chemotherapy. Further researches on different schedules of taxanes demonstrated lower dose but more frequent administration might provide equal effects but less toxicities. With therapy targeted human epidermal growth factor receptors, trastuzumab which is an anti-Her-2 monoclonal antibody, combined with chemotherapy showed a greater progression free survival rate and reduction of relapse in trials of early breast cancer. Lapatinib is a small molecules tyrosine kinase inhibitor which can interrupt the signal transduction pathway from Her-2 and Her-1 and with combination of capecitabine can be a choice after failure of trastuzumab in patients of Her-2 overexpression metastatic breast cancer. Bevacizumab, an anti-vascular endothelial growth factor receptor monoclonal antibody, which associates with tumor angiogenesis pathway is another choice of targeted therapy. Combination use with pacitaxel or docetaxel provided a longer progression free survivial for patients of metastatic breast cancer. Capecitabine and gemcitabine also provided a longer survival while combination with taxanes and thus were approved by US Food and Drug Administration. In summary, more and more choices for treatment of breast cancer patients are provided. A balance of cost-benefit and quality of life to achieve cure or prolong life is of great concern for an experienced physician and one's team.