Practical recommendations for the treatment of patients with breast cancer (article 2)

Abstract

Background. Breast cancer is one of the most widespread malignant diseases among women in the world. For the last few years, its rate has constituted about 20% of all tumor diseases in women. The annual standardized morbidity growth rate in Ukraine was 1,8% in the last decade. The cumulative risk of breast cancer development is 5,4% given that the life duration is 74 years. Treatment of patients with breast cancer. The treatment must be planned by several medical specialists including a surgical oncologist, a radiation therapist, a chemotherapist, and, if possible, a pathologist. This will allow local and systematic tumor therapy methods to be combined in the best way possible.
 Purpose – to systematize, generalize, and present the research data on modern approaches to diagnostic measures, movement of patients, and sequence of treatment approaches for locally advanced and metastatic breast cancer from the perspective of the Ukrainian healthcare system. Materials and methods. The article covers modern full-text publications, screening, and treatment protocols of patients with breast cancer, which were obtained from international and domestic sources and databases (e-catalog of Vernadsky National Library of Ukraine, Web of Science, Core Collection, Pubmed).
 Results. Місцево-поширений первинно-неоперабельний інвазивний рак грудної залози РГЗ, в тому числі інфільтративно-набрякова форма є первинно неоперабельними і вимагають призначення медикаментозної терапії на першому етапі лікування. Locally advanced primarily inoperable invasive breast cancer, including infiltrativeedematous form, is primarily inoperable and requires the prescription of drug therapy at the first stage of the treatment. Triple-negative and HER-2-dependent tumors also require presurgical drug therapy. Local treatment (surgery, radiation therapy) at the first stage is not indicated. The main goal of drug therapy in primarily inoperable forms of breast cancer is the reduction in the size of the tumor in order to achieve an operable condition. Presurgical drug therapy in primarily inoperable forms of breast cancer is carried out under the same rules as in primarily operable ones. Therapy of isolated local recurrences is aimed at full recovery and must be performed similarly to the treatment of primary tumor and involve necessary diagnostic and treatment methods (the diagrams are given in article 1). The treatment of advanced, disseminated breast cancer is palliative and intended to improve the quality of life and increase its duration. The main treatment method for metastatic disease is drug therapy. There is no single treatment standard for metastatic breast cancer. Selection of the drug therapy option is performed taking into account biological markers and clinical-anamnestic features of the patient. On the condition that individual approaches to the treatment of patients with breast cancer are used, the following improvements are quite possible: an increase in both recurrence-free and overall survival, a decrease in the number of complications and toxic manifestations, better compliance of the patients and improvement of their life quality. Systematization and individualization of treatment regimens, depending on the stage of the tumor process and biological features of the tumor, allow the practicing physician to plan and predict the types and the sequence of antitumor therapy.
 Conclusions. The deepening of our knowledge of breast cancer pathogenesis will contribute to the deeper implementation of individual approaches to the treatment of patients with this pathology. Continuous search will certainly lead to the appearance of new groups of drugs which may change the existing standards of treatment. The use of new pathogenetically relevant methods of biological, hormonal, and target therapy in the modern standards of treatment will allow both recurrence-free and overall survival of the patients to be increased.