BREAST CANCER: THE LATEST EVIDENCES IN DRUG THERAPY

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Abstract

High-dose fulvestrant provided an effective second-line therapy for postmenopausal women who had progressed after previous endocrine therapy (CONFIRM). Everolimus plus exemestane improves progression-free survival (PFS) for postmenopausal women with hormone-receptor positive breast cancer (BOLERO-2). The concept of complete HER2 blockade with biologic agents gained efficacies in pathological complete response (pCR) of several phase III studies in the neoadjuvant setting. Neo-ALTTO, which compares lapatinib, trastuzumab, and lapatinib/trastuzumab combination therapy, showed the combination proved superior. In another four-arm neoadjuvant trial (NeoSphere), the combination with pertuzumab, trastuzumab, and docetaxel produced 50% more pCRs than were achieved with trastuzumab and docetaxel. In addition, combination without chemotherapy was capable of eradicating the tumor in a remarkable number of cases (17%). In an interim analysis of ALTTO study; an adjuvant trial which compare with monotherapy or combination of HER2 inhibitors, the safety/monitoring committee concluded that the lapatinib alone arm is unlikely to meet the pre-specified criteria to demonstrate non-inferiority to trastuzumab alone with respect to disease-free survival. Pertuzumab plus trastuzumab plus docetaxel improves PFS in human epidermal growth factor receptor type 2 (HER2)-positive metastatic breast cancer (CLEOPATRA) in comparison with trastuzumab plus docetaxel. Trastuzumab emtansine; T-DM1, an antibody-guided drug, also improves PFS in randomized phase II compared with trastuzumab/docetaxel. MARIANNE in the first-line and EMILIA in the second-line setting will show the efficacy of T-DM1 plus pertuzumab and single T-DM1, respectively. A phase III study (EMBRACE) of eribulin mesylate versus treatment of physician's choice demonstrated that eribulin had an efficacy in overall survival (OS) in a heavily pretreated locally advanced or metastatic breast cancer. The FDA has ruled to withdraw the bevacizumab indication to breast cancer indication. Phase III showed that Iniparib, PARP inhibitor, failed to extend OS or PFS in triple negative breast cancer.

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