Novel therapeutic approaches to the treatment of metastatic breast cancer

Fernández, Yolanda; Cueva, Juan; Palomo, Andrés García; Ramos, Manuel; Juan, Ana De; Calvo, Lourdes; García-Mata, Jesús; García-Teijido, Paula; Peláez, Ignacio; García-Estévez, Laura

doi:10.1016/j.ctrv.2009.10.001

Cited by 48 publications

(36 citation statements)

References 95 publications

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“…Novel aromatase inhibitors (AIs) and drugs that target specific pathways (i.e., mTOR and CDK4/6 inhibitors) become available, and new chemotherapies were introduced (ixabepilone and eribulin) along with highly effective HER2-targeted combination therapies for HER2?ve cancers including the HR?ve/ HER2?ve tumors. These novel therapies improved response rates (RRs) and increased median progressionfree survival (PFS) with variable but often modest or added toxicity [1,2]. The preponderance of first-line treatment options also poses challenges on how to sequence the several effective therapies.…”

Section: Introductionmentioning

confidence: 98%

A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer

Generali

Venturini

Rognoni

et al. 2015

Breast Cancer Res Treat

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The goal of this study was to compare the efficacy and toxicity of chemotherapy to exemestane plus everolimus (EXE/EVE) through a network meta-analysis (NMA) of randomized controlled trials. NMA methods extend standard pairwise meta-analysis to allow simultaneous comparison of multiple treatments while maintaining randomization of individual studies. The method enables "direct" evidence (i.e., evidence from studies directly comparing two interventions) and "indirect" evidence (i.e., evidence from studies that do not compare the two interventions directly) to be pooled under the assumption of evidence consistency. We used NMA to evaluate progression-free survival (PFS) and time to progression (TTP) curves in 34 studies, and response rate (RR) and the hazard ratios (HRs) of the PFS/TTP in 36 studies. A number needed to treat (NNT) analysis was also performed as well as descriptive comparison of reported toxicities. The NMA for PFS/TTP curves and for HR shows EXE/EVE is more efficacious than capecitabine plus sunitinib, CMF, megestrol acetate and tamoxifen, with an average of related-PFS/TTP difference ranging from about 10 months for capecitabine plus sunitinib to more than 6 months for tamoxifen. The NMA for overall RR shows that EXE/EVE provides a better RR than bevacizumab plus capecitabine, capecitabine, capecitabine plus sorafenib, capecitabine plus sunitinib, CMF, gemcitabine plus epirubicin plus paclitaxel, EVE plus tamoxifen, EXE, FEC, megestrol acetate, mitoxantrone, and tamoxifen. Finally, the NMA for NNT shows that EXE/EVE is more beneficial as compared to BMF, capecitabine, capecitabine plus sunitinib, CMF, FEC, megestrol acetate, mitoxantrone, and tamoxifen. The combination of EXE/EVE as first- or second-line therapy for ER+ve/HER2-ve metastatic breast cancer is more efficacious than several chemotherapy regimens that were reported in the literature. Toxicities also favored EXE/EVE in most instances.

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Section: Introductionmentioning

confidence: 98%

A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer

Generali

Venturini

Rognoni

et al. 2015

Breast Cancer Res Treat

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“…Another very recent area of application for MMC is in patients with triple-negative breast carcinoma. Thereisastrongneedforalternativetherapeuticoptions,especiallyforpatientswithprogressoftherecommendedfirstlinetherapypaclitaxel/bevacizumab [1].MMC(e.g.incombinationwithcarboplatin)maydevelopoverthenextfewyears tobecomeavaluableoptionhere [44,45,51].Furtherphase IIIstudiesarenecessarytoprovethementionedresults.The treatments described can usually be carried out on an outpatientbasis.Whenthetoxicityprofilesareacceptable,avery goodqualityoflifeismaintained.Inthelastfewyears,alarge numberofnewanti-cancerdrugshavebeenintroducedinthe clinical setting, most of them with a specific intra-or extracellular target [2]. But also in times of a more 'biological therapy', MMC will not be replaced completely by these drugs,becauseonlyasmallpartofthemhasasuperiorefficacyincomparisontoconventionalchemotherapyagentslike MMC.SoMMCwill-togetherwithotherconventionalcytotoxicdrugs-retainitsroleinthesalvagetreatmentofMBC.…”

Section: Discussionmentioning

confidence: 99%

“…Developmentsinchemotherapyforgynecologicaltumorsand breast carcinoma in recent years have been marked by the developmentandmarketintroductionofnewagents,someof themwithnewmechanismsofeffect.Examplesthatmightbe mentioned include trastuzumab, bevacizumab, liposomally encapsulateddoxorubicin,topotecan,capecitabine,gemcitabine, andlapatinib [1][2][3].Despitethese(new)developments,tried andtestedcytostaticagentsforuseincombinationtreatments orforsalvagetherapyhaveremainedanindispensablepartof gynecological oncology. Mitomycin C (MMC) has an estab- …”

Section: Introductionmentioning

confidence: 99%

Mitomycin C in Patients with Gynecological Malignancies

et al. 2010

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Mitomycin C (MMC) is an effective cytostatic agent used in the treatment of patients with gynecological malignancies and breast carcinoma. This review presents and discusses the current treatment options with MMC in patients with breast, cervical, and vulvar carcinomas, as well as rarer gynecological malignancies. New combinations and developments are also presented and their potential clinical relevance is examined. Consequently, also for the next years a MMC-containing chemotherapy continues to be a relevant part of an individualized therapy despite numerous innovative new drugs, especially for the salvage therapy of metastatic breast cancer and the simultaneous radiochemotherapy of other gynecological malignancies.

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“…[ 2,3 ] Despite recent advances in cancer therapy, the survival of metastatic breast cancer patients is still extremely low with the fi ve-year survival rate being only about 20%. [ 6,7 ] sequential targeting of lung metastases of breast cancer tumors to improve the anti-metastatic effi cacy. We hypothesize that PWMs can be delivered to the site of the metastases by sequential targeting, in which they can fi rst be transported to the lung tissues and even the metastatic nodules by employing the unique nanostructure, and then be internalized into the cancer cells and facilitate the on-demand drug release in response to the acidic intracellular environments ( Scheme 1 ).…”

Section: Introductionmentioning

confidence: 99%

pH‐Responsive Wormlike Micelles with Sequential Metastasis Targeting Inhibit Lung Metastasis of Breast Cancer

Bao

et al. 2015

Adv Healthcare Materials

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Cancer metastasis is the main cause for the high mortality in breast cancer patients. Herein, we first report succinobucol-loaded pH-responsive wormlike micelles (PWMs) with sequential targeting capability to inhibit lung metastasis of breast cancer. PWMs can in a first step be delivered specifically to the sites of metastases in the lungs and then enable the intracellular pH-stimulus responsive drug release in cancer cells to improve the anti-metastatic effect. PWMs are identified as nanofibrillar assemblies with a diameter of 19.9 ± 1.9 nm and a length within the 50-200 nm range, and exhibited pH-sensitive drug release behavior in response to acidic intracellular environments. Moreover, PWMs can obviously inhibit the migration and invasion abilities of metastatic 4T1 breast cancer cells, and reduce the expression of the metastasis-associated vascular cell adhesion molecule-1 (VCAM-1) at 400 ng mL(-1) of succinobucol. In particular, PWMs can induce a higher specific accumulation in lung and be specifically delivered to the sites of metastases in lung, thereby leading to an 86.6% inhibition on lung metastasis of breast cancer. Therefore, the use of sequentially targeting PWMs can become an encouraging strategy for specific targeting and effective treatment of cancer metastasis.

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Novel therapeutic approaches to the treatment of metastatic breast cancer

Cited by 48 publications

References 95 publications

A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer

A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer

Mitomycin C in Patients with Gynecological Malignancies

pH‐Responsive Wormlike Micelles with Sequential Metastasis Targeting Inhibit Lung Metastasis of Breast Cancer

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