Breast cancer typing and targeted drugs

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Breast cancer situation 

Approximately every 10-12% of breast cancer patients in the world are in India, and nearly two-thirds of patients are diagnosed with advanced cancer at the time of diagnosis. Experts analyzed that there should be 50,000 to 60,000 HER2-positive breast cancer patients in India, and less than 20% of the confirmed patients received anti-HER2 treatment. “This means that more than 80% of patients do not get targeted treatment, and the best treatment opportunities are lost.”

According to the data, when receiving targeted therapy based on chemotherapy, the risk of recurrence of HER2-positive breast cancer patients was reduced by about 40%, the risk of death was reduced by nearly 30%, and the ten-year survival rate was increased by more than 8%. At present, the treatment of breast cancer has entered the era of individualized and precise treatment. However, due to different detection levels and analysis levels, different testing institutions in China will give different test results, which will greatly affect the treatment results of patients.

Breast cancer study

According to the results of the University of Washington’s “JAMA Oncology”, American experts believe: “Our findings suggest that the results of genetic tests may vary significantly, depending on which test the patient applies.” Global Oncologist Network experts believe that patients The selected genetic testing institution can ensure the accuracy of the test results as much as possible, the accuracy of clinical drug analysis, and avoid the difference in the treatment results.

In 2007, the American Society of Clinical Oncology (ASCO) announced that breast cancer 21 gene testing should be considered for patients with early breast cancer who are positive for estrogen receptors and have not spread lymph nodes during the development of a breast cancer treatment plan. The National Cancer Center System (NCCN) recommended the use of the breast cancer 21 gene test in its 2008 breast cancer treatment guidelines.

Breast cancer 21 gene test refers to the detection of the expression levels of 21 different genes in breast cancer tumor tissues, including 16 breast cancer-related genes and 5 reference genes. This test can provide individualized prediction of treatment effects and 10-year risk of recurrence. prediction. By detecting 21 genes and observing their interactions to determine tumor characteristics, the breast cancer recurrence index and the benefit ratio of chemotherapy can be predicted.

Breast cancer 21 gene test is mainly applicable to newly diagnosed breast cancer patients who are in stage I or II, positive for estrogen receptor, negative for lymph node metastasis, and will be treated with tamoxifen. After menopause, patients with aggressive lymphoma who are positive for lymph nodes and estrogen receptors can also use the 21 gene test to determine the benefit of chemotherapy.

Precision treatment for breast cancer

Breast cancer is not a single disease. Generally speaking, breast cancer can be divided into four types: LuminalA, LuminalB, HER2 positive, and triple negative according to different indicators such as ER, PR, HER2, and Ki67. Luminal A and Luminal B are the most common molecular subtypes of breast cancer, accounting for more than 60% of all breast cancers, and have a good prognosis. The prognosis for HER2 positive and triple negative is relatively poor. Among them, HER2-positive breast cancer is a highly dangerous subtype of breast cancer, and about 20% -30% of breast cancer patients are HER2-positive. According to the genotyping of breast cancer, find corresponding treatment and targeted drugs.

Targeted drugs for breast cancer

Trastuzumab (Herceptin) was launched in 1998 and has a good effect on many HER2-positive breast cancer patients. The results of clinical trials suggest that trastuzumab adjuvant therapy can effectively and effectively reduce the risk of recurrence, making more HER2 Patients with positive early breast cancer benefit for more than 10 years. Lapatinib (Tykerb) Lapatinib is an oral, reversible tyrosine kinase inhibitor that inhibits both tumor cell epidermal growth factor receptor (EGFR, HER1) and HER2 tyrosine phosphate Effect is significantly better than drugs that only inhibit one of the targets. This drug is the second molecularly targeted drug approved for marketing to breast cancer after trastuzumab, mainly for the treatment of advanced breast cancer. Bevacizumab (trade name Avastin) A recombinant humanized monoclonal antibody that blocks VEGF-mediated biological activity by competitively binding to VEGF receptors with vascular endothelial growth factor (VEGF), thereby inhibiting endothelial Mitosis of cells reduces tumor neovascularization and achieves the effect of inhibiting tumor growth. It is the first drug approved to inhibit tumor angiogenesis. Lenatinib (Neratinib / Noratinib) is an oral, irreversible HER1,2 and 4 inhibitor. Afatinib Afatinib is an oral small molecule drug that has irreversible inhibitory effects on HER1,2 and 4.

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