Taxanes in the treatment of breast cancer: Have we better defined their role in older patients? A position paper from a SIOG Task Force

Biganzoli, Laura; Aapro, Matti; Loibl, Sibylle; Wildiers, Hans; Brain, Étienne

doi:10.1016/j.ctrv.2015.11.009

“…The major challenge that faces clinicians when treating BC patients is the severe toxic side effects that are produced by taxane, and especially among the elderly patients [13]. The major side effects include: myelosuppression, neutropenia and neuropathy [13].…”

Section: Clinical Challenges In Mbc-comparing Taxane To Nabpaclitaxelmentioning

confidence: 99%

Untitled

2017

MOJCSR

0

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Breast cancer (BC) remains the most invasive diagnosed cancers among female, affecting 25% of total number of cancers worldwide. Systematic chemotherapies still remain one of the effective treatments for BC. One of the common and powerful chemotherapies that have been used in the past decade is taxane. Taxane are a class of anticancer compounds that are known to cause cell cycle arrest and apoptosis induction (cell death). They are used for the treatment of malignant tumors specifically BC along with other chemotherapies such as anthracycline. However, the neurotoxic effects that are associated with the use of taxane are still challenging. Recently, nanoparticle albumin bound taxane (nab-paclitaxel) was developed, resulting in lowering of the side effects that are associated with the use of taxane and enhancing its delivery to the targeted cancer cells. Nab-paclitaxel has been subjected to several clinical trials to evaluate its efficacy in the treatment of various types of cancers including BC. The results indicated that nab-paclitaxel showed an improved efficacy and promising outcomes in the treatment of various forms of BC. This review focuses on the comparison of classical taxane to the new generation, nab-paclitaxel chemotherapy, with emphasis on their comparative efficacy in metastatic BC (MBC) and triple negative metastatic BC (TNMBC) treatment, concluding that nab-paclitaxel has improved efficacy, safety data and with a more convenient administration confirming an optimal treatment option for patients in both cases. Future work is needed to optimize dosing schedules and combination regimens of nab-paclitaxel, which could broaden the clinical utility of this agent.

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“…Taxane were used in combination with anthracycline and other alkylating agents in order to improve the overall survival (OS) rate, and disease free survival (DFS) among metastatic BC (MBC) patients [10,11]. Therefore, taxane chemotherapy still remains an effective treatment for BC and is considered as the first line of therapy used for the treatment of MBC with success rate ranging from 25% to 69% [12,13]. There are two main types of taxane: paclitaxel and docetaxelsecond generation [14].…”

Section: Introductionmentioning

confidence: 99%

“…The US Food and Drug Administration (FDA) was the first to approve paclitaxel for treating ovarian cancer in 1992 and subsequently for the treatment of MBC in 1994 [15]. In addition, taxane chemotherapy has been included in the management of early stage BC and issued routinely in combination with trastuzumab (Herceptin®) and anthracycline [11,13,14]. However, paclitaxel resulted in the induction of a high cytotoxicity in BC patients and especially among the elderly ones [13].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, taxane chemotherapy has been included in the management of early stage BC and issued routinely in combination with trastuzumab (Herceptin®) and anthracycline [11,13,14]. However, paclitaxel resulted in the induction of a high cytotoxicity in BC patients and especially among the elderly ones [13]. The major side effects resulting from its use in BC patients include myelosuppression and neuropathy [13].…”

Section: Introductionmentioning

confidence: 99%

“…However, paclitaxel resulted in the induction of a high cytotoxicity in BC patients and especially among the elderly ones [13]. The major side effects resulting from its use in BC patients include myelosuppression and neuropathy [13]. Paclitaxel induce neuropathy primarily by injuring the dorsal root ganglia (DRG) neurons leading to a sequence of Neuropathological alterations in the DRG, dorsal horn of the spinal cord and peripheral nerve [16].…”

Section: Introductionmentioning

confidence: 99%

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Classical Taxane versus the New Generation, Nab-Paclitaxel Chemotherapy in the Treatment of Breast Cancer

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Breast cancer (BC) remains the most invasive diagnosed cancers among female, affecting 25% of total number of cancers worldwide. Systematic chemotherapies still remain one of the effective treatments for BC. One of the common and powerful chemotherapies that have been used in the past decade is taxane. Taxane are a class of anticancer compounds that are known to cause cell cycle arrest and apoptosis induction (cell death). They are used for the treatment of malignant tumors specifically BC along with other chemotherapies such as anthracycline. However, the neurotoxic effects that are associated with the use of taxane are still challenging. Recently, nanoparticle albumin bound taxane (nab-paclitaxel) was developed, resulting in lowering of the side effects that are associated with the use of taxane and enhancing its delivery to the targeted cancer cells. Nab-paclitaxel has been subjected to several clinical trials to evaluate its efficacy in the treatment of various types of cancers including BC. The results indicated that nab-paclitaxel showed an improved efficacy and promising outcomes in the treatment of various forms of BC. This review focuses on the comparison of classical taxane to the new generation, nab-paclitaxel chemotherapy, with emphasis on their comparative efficacy in metastatic BC (MBC) and triple negative metastatic BC (TNMBC) treatment, concluding that nab-paclitaxel has improved efficacy, safety data and with a more convenient administration confirming an optimal treatment option for patients in both cases. Future work is needed to optimize dosing schedules and combination regimens of nab-paclitaxel, which could broaden the clinical utility of this agent.

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Bringing 3D tumor models to the clinic – predictive value for personalized medicine

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Current decision-guiding algorithms in cancer drug treatment are based on decades of research and numerous clinical trials. For the majority of patients, this data is successfully applied for a systemic disease management. For a number of patients however, treatment stratification according to clinically based risk criteria will not be sufficient. The most effective treatment options are ideally identified prior to the start of clinical drug therapy. This review will discuss the implementation of three-dimensional (3D) cell culture models as a preclinical testing paradigm for the efficacy of clinical cancer treatment. Patient tumor-derived cells in 3D cultures duplicate the individual tumor microenvironment with a minimum of confounding factors. Clinical implementation of such personalized tumor models requires a high quality of methodological and clinical validation comparable to other biomarkers. A non-systematic literature search demonstrated the small number of prospective studies that have been conducted in this area of research. This may explain the current reluctance of many physicians and insurance providers in implementing this type of assay into the clinical diagnostic routine despite potential benefit for patients. Achieving valid and reproducible results with a high level of evidence is central in improving the acceptance of preclinical 3D tumor models.

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Taxanes in the treatment of breast cancer: Have we better defined their role in older patients? A position paper from a SIOG Task Force

Cited by 49 publications

References 73 publications

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Classical Taxane versus the New Generation, Nab-Paclitaxel Chemotherapy in the Treatment of Breast Cancer

Bringing 3D tumor models to the clinic – predictive value for personalized medicine

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