Effective oral chemotherapy for breast cancer: pillars of strength

Abstract

Traditionally, anticancer therapy has been dominated by intravenous drug therapy. However, oral agents provide an attractive approach to chemotherapy and use of oral treatments is increasing. We discuss the benefits and challenges of oral chemotherapy from the perspectives of patients, healthcare providers and healthcare funders. Important issues include patient preference, efficacy, compliance, bioavailability, reimbursement, use in special patient populations, financial and staff time savings and flexibility of dosing. We review data for traditional oral agents (e.g. cyclophosphamide, methotrexate), newer oral chemotherapies (e.g. capecitabine), oral formulations of traditionally intravenous agents (e.g. vinorelbine, idarubicin) and new biologic agents under evaluation in breast cancer (e.g. tyrosine kinase inhibitors). Lastly, we review studies of all-oral combination regimens. The wealth of data available and the increasing use of oral agents in breast cancer suggest that many of the concerns and perceptions about oral therapy, including efficacy and bioavailability, have been overcome, and that oral therapy will play a major role in breast cancer management in the future in both the metastatic and adjuvant settings. Key words: breast cancer, capecitabine, oral chemotherapy, vinorelbine introduction Cancer treatment has traditionally been dominated by intravenous drug therapy [1]. There has, however, been a steady increase in the number of oral anticancer agents available during recent years, offering obvious benefits in terms of convenience and ease of administration, as well as addressing patients' preference for oral therapy [2][3][4][5]. It is estimated that one-quarter of all anticancer agents under development are oral agents [6]. Several agents that are already approved in a range of tumour types (e.g. capecitabine, erlotinib, gefitinib, imatinib, lapatinib, lenalidomide, thalidomide, sunitinib, sorafenib) and many others in development (e.g. vatalanib, satraplatin) are or will be available only as oral formulations. Novel approaches to drug delivery, such as the development of hydrophilic polymer carriers to deliver drugs to the gut [7], are likely to further increase the number of oral drugs available.This review investigates the impact of the expanding range of oral agents on cancer treatment, focusing on issues that have previously prevented the use of oral agents in patients with cancer and the opportunities that oral therapy offers. Oral agents that are already available, or that are under clinical evaluation for the treatment of breast cancer, are profiled to illustrate the potential of oral chemotherapy in this patient group.defining the ideal oral agent the patient's perspective Several surveys have shown that most patients prefer oral to intravenous therapy [3,4,8]. Nevertheless, a minority of patients prefer intravenous therapy because they believe that oral therapy is less effective than intravenous treatment [5,8,9]. In a survey of 59 patients starting oral chemotherapy for advanced breas...

A Systematic Review of Adherence to Oral Antineoplastic Therapies

“…During the last two decades, oral antineoplastic agents have increasingly become a primary form of treatment for many cancers, ranging from traditional endocrine and cytotoxic therapies to formulations targeting genetic mutations [1,2]. Advances in oral therapies have not only improved outcomes and survival in patients with cancer but also have reduced the burden of care by allowing for convenient dosing outside of the hospital without the need for nurse administration and intravenous infusion [3].…”

Effects of Lycopene Alone or Combined with Melatonin on Methotrexate-Induced Nephrotoxicity in Rats

“…Methotrexate (Mtx), an antifolate, is used as an anti-cancer drug in higher doses such as lymphoma, breast carcinoma, sarcoma, breast cancer (Choudhury et al, 2000;Miyazaki et al, 2003;Seigers et al, 2008;Findlay et al, 2008;D'Adamo, 2011) and also in lower doses in the treatment of rheumatic diseases, psoriasis, refractory inflammatory bowel disease since it has immunosuppressant effect (Peters et al, 2000;Gisondi and Girolomoni, 2007;Renna, 2014).…”

Assessment and Measurement of Adherence to Oral Antineoplastic Agents

“…1 Daily or more frequent dosing provides numerous opportunities to modify the dose and effectively manage side effects, also making oral antineoplastic agents more attractive. However, adherence to oral antineoplastics is a major obstacle to successful oncology treatment, while over adherence can lead to potentially life-threatening toxicity.…”

“…1,2 Consequently, clinicians need to conduct ongoing assessment and measurement to assure that a prescribed oral antineoplastic agent is taken appropriately. 3 In this paper, the assessment and measurement of adherence to oral antineoplastic agents for cancer treatment are discussed.…”