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By the side of West Lake, big coffee talks about it.
On May 14-16, 2021, the 5th Hangzhou Xianghu International Breast Cancer Summit (HXIBCS) and the 6th Hangzhou Xianghu Breast Cancer Forum for Young and Middle-aged People will be held in Hangzhou.
This conference brought together well-known experts and scholars in the field of breast cancer at home and abroad to discuss the new progress of breast cancer diagnosis and treatment, presenting a wonderful academic feast.
Yimaitong was fortunate to invite Professor Xie Yanru from the Department of Oncology, Lishui Central Hospital, to share on "the application of TKI drugs in HER2-positive breast cancer patients".
Expert profile Professor Xie Yanru, Director of the Department of Oncology, Lishui Central Hospital, Zhejiang Province Secretary of the Lishui Office of Cancer Prevention and Treatment, Secretary of the Office of Cancer Prevention and Treatment of Lishui, Member of the Special Committee of Breast Cancer, Zhejiang Anticancer Association, Member of the Special Committee of Cancer Prevention and Control, Zhejiang Anticancer Association Member of the Chemotherapy Special Committee Member of the Breast Cancer Special Committee of the Zhejiang Branch of the Chinese Medical Association Yi Maitong, Deputy Chairman of the Breast and Thyroid Disease Professional Committee of the Integrative Medicine Association: Small molecule tyrosine kinase inhibitors (TKI) targeting HER2-positive breast cancer have been widely used in clinical practice.
Could you please introduce what are currently available in China? TKI drugs approved? Professor Xie Yanru: Breast cancer is the most common malignant tumor in women in my country.
20%-30% of breast cancer patients overexpress HER2.
Effective anti-HER-2 targeted therapy is an important means to improve the prognosis.
At present, the main TKI drugs used in clinical practice in China include pyrrotinib, lapatinib and neratinib.
Since lapatinib is no longer in the scope of medical insurance reimbursement, the frequency of use will be relatively reduced.
In addition, tucatinib is also expected to be listed in China.
Yimaitong: Could you please talk about how domestic and foreign guidelines recommend TKI drugs that target HER2-positive breast cancer? Professor Xie Yanru: For patients who have failed trastuzumab treatment, the NCCN guidelines recommend the second-line use of the antibody-conjugated drug enmetrastuzumab (T-DM1) for treatment; and the 2021 Chinese CSCO guidelines will include pirotinib + card Peitabine is recommended as level I (1A).
The recommendations of the two guidelines are based on drug research data.
The level of evidence on T-DM1 abroad is relatively high, so the NCCN guidelines recommend T-DM1, while the domestic research evidence on pyrrotinib is more.
The PHENIX study showed that in patients who failed the treatment of taxanes and trastuzumab, pyrrotinib combined with capecitabine can improve the objective response rate (ORR) and progression-free survival ( PFS).
The PHOEBE study showed that in patients with advanced breast cancer who had previously received trastuzumab, taxanes, and/or anthracyclines, the PFS of the pyrrotinib combined with capecitabine group was better than that of the lapatinib combined with card.
Petabine group.
Therefore, the CSCO guidelines put pyrrotinib combined with capecitabine as a level I recommendation.
The formulation of my country's CSCO guidelines will be adjusted in accordance with China's national conditions and phase III clinical studies in line with the Chinese population on the basis of reference to foreign guidelines, while taking into account the availability of domestic drugs and changes in medical insurance policies, which is more instructive.
Yimaitong: Could you please tell us, for patients with HER2-positive advanced breast cancer who have failed trastuzumab treatment, do you prefer macromolecular monoclonal antibody therapy or TKI? Professor Xie Yanru: It is necessary to distinguish whether patients who have failed trastuzumab treatment are primary or secondary resistance.
For patients with secondary drug resistance, the treatment of macromolecular monoclonal antibodies combined with TKI can be continued; for patients with primary drug resistance, there is not much clinical controversy.
From the perspective of trastuzumab resistance mechanism, small molecule TKI drugs can be used.
Into the cell, the macromolecular monoclonal antibody acts on the outside of the cell, and TKI drugs can better reverse drug resistance, so TKI drugs are more inclined to choose.
In addition, the location of metastasis in patients who progressed after trastuzumab treatment failure should be considered.
For patients with brain metastases, small molecule TKI drugs are better than macromolecular monoclonal antibodies in terms of molecular weight.
Macromolecular monoclonal antibodies used in the study of brain metastases patients are far from achieving tumor suppression effects, so follow-up treatment is still more inclined For TKI drugs.
On May 14-16, 2021, the 5th Hangzhou Xianghu International Breast Cancer Summit (HXIBCS) and the 6th Hangzhou Xianghu Breast Cancer Forum for Young and Middle-aged People will be held in Hangzhou.
This conference brought together well-known experts and scholars in the field of breast cancer at home and abroad to discuss the new progress of breast cancer diagnosis and treatment, presenting a wonderful academic feast.
Yimaitong was fortunate to invite Professor Xie Yanru from the Department of Oncology, Lishui Central Hospital, to share on "the application of TKI drugs in HER2-positive breast cancer patients".
Expert profile Professor Xie Yanru, Director of the Department of Oncology, Lishui Central Hospital, Zhejiang Province Secretary of the Lishui Office of Cancer Prevention and Treatment, Secretary of the Office of Cancer Prevention and Treatment of Lishui, Member of the Special Committee of Breast Cancer, Zhejiang Anticancer Association, Member of the Special Committee of Cancer Prevention and Control, Zhejiang Anticancer Association Member of the Chemotherapy Special Committee Member of the Breast Cancer Special Committee of the Zhejiang Branch of the Chinese Medical Association Yi Maitong, Deputy Chairman of the Breast and Thyroid Disease Professional Committee of the Integrative Medicine Association: Small molecule tyrosine kinase inhibitors (TKI) targeting HER2-positive breast cancer have been widely used in clinical practice.
Could you please introduce what are currently available in China? TKI drugs approved? Professor Xie Yanru: Breast cancer is the most common malignant tumor in women in my country.
20%-30% of breast cancer patients overexpress HER2.
Effective anti-HER-2 targeted therapy is an important means to improve the prognosis.
At present, the main TKI drugs used in clinical practice in China include pyrrotinib, lapatinib and neratinib.
Since lapatinib is no longer in the scope of medical insurance reimbursement, the frequency of use will be relatively reduced.
In addition, tucatinib is also expected to be listed in China.
Yimaitong: Could you please talk about how domestic and foreign guidelines recommend TKI drugs that target HER2-positive breast cancer? Professor Xie Yanru: For patients who have failed trastuzumab treatment, the NCCN guidelines recommend the second-line use of the antibody-conjugated drug enmetrastuzumab (T-DM1) for treatment; and the 2021 Chinese CSCO guidelines will include pirotinib + card Peitabine is recommended as level I (1A).
The recommendations of the two guidelines are based on drug research data.
The level of evidence on T-DM1 abroad is relatively high, so the NCCN guidelines recommend T-DM1, while the domestic research evidence on pyrrotinib is more.
The PHENIX study showed that in patients who failed the treatment of taxanes and trastuzumab, pyrrotinib combined with capecitabine can improve the objective response rate (ORR) and progression-free survival ( PFS).
The PHOEBE study showed that in patients with advanced breast cancer who had previously received trastuzumab, taxanes, and/or anthracyclines, the PFS of the pyrrotinib combined with capecitabine group was better than that of the lapatinib combined with card.
Petabine group.
Therefore, the CSCO guidelines put pyrrotinib combined with capecitabine as a level I recommendation.
The formulation of my country's CSCO guidelines will be adjusted in accordance with China's national conditions and phase III clinical studies in line with the Chinese population on the basis of reference to foreign guidelines, while taking into account the availability of domestic drugs and changes in medical insurance policies, which is more instructive.
Yimaitong: Could you please tell us, for patients with HER2-positive advanced breast cancer who have failed trastuzumab treatment, do you prefer macromolecular monoclonal antibody therapy or TKI? Professor Xie Yanru: It is necessary to distinguish whether patients who have failed trastuzumab treatment are primary or secondary resistance.
For patients with secondary drug resistance, the treatment of macromolecular monoclonal antibodies combined with TKI can be continued; for patients with primary drug resistance, there is not much clinical controversy.
From the perspective of trastuzumab resistance mechanism, small molecule TKI drugs can be used.
Into the cell, the macromolecular monoclonal antibody acts on the outside of the cell, and TKI drugs can better reverse drug resistance, so TKI drugs are more inclined to choose.
In addition, the location of metastasis in patients who progressed after trastuzumab treatment failure should be considered.
For patients with brain metastases, small molecule TKI drugs are better than macromolecular monoclonal antibodies in terms of molecular weight.
Macromolecular monoclonal antibodies used in the study of brain metastases patients are far from achieving tumor suppression effects, so follow-up treatment is still more inclined For TKI drugs.
