Professor Ma Fei: Regarding the latest treatment progress in the field of breast cancer, you need to know this!

*Only for medical professionals to read about breast cancer treatment, there are authoritative voices here! Both at home and abroad, breast cancer is the most common malignant tumor among women, seriously endangering women's life and health.

What are the current advanced treatments for breast cancer? How effective are the various treatment methods? What drugs are available for targeted therapy? With these issues that the public and patients are most concerned about, the medical community has a dialogue with the authoritative expert-Professor Ma Fei, Director of the Internal Medicine Treatment Center of the National Cancer Center/Tumor Hospital of the Chinese Academy of Medical Sciences, and asked him to share his views on the diagnosis and treatment of breast cancer, and promote the public to this An understanding of malignant diseases.

 Breast cancer prevention and control, screening and treatment are equally important.
Professor Ma Fei's wonderful video Professor Ma Fei introduced that in 2020, breast cancer has surpassed lung cancer to become the world's number one new malignant tumor.

In China, breast cancer has always been the malignant tumor with the highest incidence rate among women, and it is growing rapidly at a rate of 3% to 4% per year.
This growth rate is not only higher than the global average, but also higher than that of developed countries in the West.

"Therefore, the future of breast cancer prevention and control in our country and even the world has always been our responsibility and responsibility.

" In the entire breast cancer prevention and control system, screening and early diagnosis and treatment are a vital link, which helps Improve the early diagnosis rate, thereby increasing the cure rate and prolonging the survival period.

Professor Ma Fei emphasized that the two groups of people need to pay special attention to breast cancer screening.

"One is the general population, that is, women aged 40 to 70.
It is recommended to undergo medical imaging screening, including X-ray and ultrasound, once every 1 to 2 years.

Second, for high-risk groups, it is generally recommended to undergo medical imaging screening once a year, except for X Screening by line and/or ultrasound, and magnetic resonance screening when necessary.

"There are three main categories of high-risk breast cancer groups: those with genetic predispositions; those with past breast lobular or ductal dysplasia, or lobular carcinoma in situ The crowd; women with a history of chest radiotherapy.

High-risk groups must undergo more stringent early screening.

The current breast cancer treatment has formed a multidisciplinary comprehensive diagnosis and treatment model with breast cancer as the core.
The main treatment methods include surgery, chemotherapy, endocrine therapy, targeted therapy, immunotherapy, radiotherapy, and traditional Chinese medicine.

For patients with early breast cancer, surgery is generally the main focus, and postoperative adjuvant treatments are carried out; for advanced patients, a comprehensive diagnosis and treatment model based on systemic treatment such as drug therapy is adopted.

 Three great tools for systemic breast cancer treatment Professor Ma Fei’s wonderful video 1.
Endocrine therapy Professor Ma Fei said that endocrine therapy is one of the important treatment strategies for breast cancer, which is mainly suitable for hormone receptor positive (HR+) breast cancer patients, including Adjuvant endocrine therapy for early patients and rescue endocrine therapy for late patients.

Patients who require long-term adjuvant therapy or maintenance therapy are more suitable for endocrine therapy.

 For patients with advanced HR+ breast cancer, endocrine therapy is often the preferred treatment strategy, but even if the effect is good, there is still a high probability that the disease progression under endocrine therapy will eventually occur, and patients will develop primary or secondary endocrine therapy resistance.

For such patients, while continuing endocrine therapy, it may be necessary to introduce targeted therapy for the resistance mechanism of endocrine therapy to realize the "endocrine +" treatment strategy, which will bring better treatment effects and longer survival time to patients.

 Professor Ma Fei pointed out that CDK4/6 inhibitors occupy an important position in the "endocrine+" treatment strategy for breast cancer.

Several existing CDK4/6 inhibitors have shown great efficacy improvement, and not only first-line treatment, second-line treatment, and even adjuvant therapy, the efficacy advantages of endocrine therapy combined with targeted therapy compared with endocrine therapy alone have also been seen.

 In the past, for advanced breast cancer, especially HR+ breast cancer, the strategy of giving priority to endocrine therapy has been adhered to clinically.

The combined treatment strategy containing CDK4/6 inhibitors further improved the efficacy on the basis of endocrine therapy alone, without significantly increasing the adverse reactions, and the quality of life of the patients was not seriously affected.

 In the future, targeted therapy represented by endocrine therapy combined with CDK4/6 inhibitors is likely to become an important strategy for advanced breast cancer, especially rescue treatment.

Whether it is patients with non-visceral metastasis or visceral metastasis, even for patients with visceral crisis, "endocrine+" may be an optional or preferred treatment strategy.

 2.
Immunotherapy In recent years, immunotherapy represented by Immune Checkpoint Inhibitors (ICI) has made breakthroughs in the entire oncology field, and breast cancer is naturally no exception.

Especially triple-negative breast cancer (TNBC), there has been a certain degree of progress in its advanced rescue treatment and neoadjuvant treatment.

 Professor Ma Fei believes that future solid tumor immunotherapy, represented by breast cancer, may need to develop in two directions.

First of all, how to define and select the dominant population of immunotherapy is a direction worthy of efforts.

Secondly, we also need to find the best partner for immunotherapy, whether combined with radiotherapy or chemotherapy, and which type of chemotherapy combined, are questions that need to be explored.

In the future, immunotherapy will play an important role in breast cancer, but it needs to be carried out more scientifically and accurately.

 Wonderful video of Professor Ma Fei 3.
Targeted therapy HER2+ is a major factor in the poor prognosis of breast cancer.

In the past, the prognosis of HER2+ breast cancer was poor and the survival period was short.
However, after the application of anti-HER2 therapy represented by trastuzumab in the clinic, the situation has been greatly improved.

At present, advanced rescue treatment can further extend the survival period of patients, and significantly improve the prognosis of HER2+ advanced breast cancer and HER2+ early breast cancer.

 Professor Ma Fei concluded, “Anti-HER2 treatment strategies mainly include three major categories.
The first is monoclonal antibodies, such as trastuzumab and
pertuzumab .
The second is pirotinib and lenatinib.
Small molecule tyrosine kinase inhibitors (TKIs) represented by lapatinib, these drugs occupy an important clinical position in anti-HER2 therapy with their unique advantages.

The third is the newly marketed antibody-conjugated drug (ADC).
The representative drugs are TDM-1 and DS8201, which bring greater survival opportunities for breast cancer patients (especially advanced patients).

"What is the difference between these three types of drugs? Professor Ma Fei said that monoclonal antibodies and ADCs belong to the two types of biological macromolecules.

In contrast, TKIs are small molecule compounds.

Both have different clinical applications.
However, compared with large molecules, small molecules have obvious advantages in four aspects: their molecular weight is smaller, they are easier to penetrate the blood-brain barrier, and they have certain advantages for the prevention and treatment of brain metastases; as a chemically synthesized drug, the cost is relatively low and the price is higher.
Inexpensive; most of them are administered orally.
Compared with intravenously administered antibody drugs, they are easy to use and have better compliance; compared with biological macromolecules, chemically synthesized small molecules are less immunogenic, so allergic reactions are significantly lower For macromolecules.

 Of course, under certain conditions, TKIs combined with antibody drugs may also have a synergistic effect and exert a better therapeutic effect.

 While the anti-HER2 treatment effect is improved and the patient’s survival period continues to extend, it should not be ignored.
The phenomenon is that the proportion or absolute clinical number of HER2+ patients with brain metastases is increasing.

For these patients, a comprehensive treatment strategy of
systemic therapy is still needed, with or without local therapy.
Systemic therapy is always the top priority .

 TKIs as a small molecule drug more easily penetrate the blood-brain barrier, higher drug concentrations in cerebrospinal fluid, for patients with brain metastases have a unique advantage.

Professor Ma Fei believes that, for this patient population, it may be necessary to consider the characteristics of the drug, factors treatment response in patients with previous treatment, and the patient's physical condition, health economics, to develop individualized treatment strategies.

 in addition, the anti-HER2 therapy or disease progression in patients still need to redouble our efforts on clinical drug resistance.

"a On the one hand, by optimizing the existing anti-HER2 treatment strategy, it will bring longer survival period and better quality of life to patients.

On the other hand, we will also actively develop new anti-HER2 therapeutic drugs to provide patients with more abundant treatment options.

"The future of breast cancer diagnosis and treatment: Standardization and innovation.
Compared with other malignant tumors, the field of breast cancer treatment has made great progress, and the 5-year survival rate has improved.
However, China still faces some problems in the diagnosis and treatment of breast cancer.

For example, and Compared with Western developed countries, we still have a 5-year survival rate gap; obvious regional differences, urban-rural differences, etc.
In the
 future, the development of breast cancer diagnosis and treatment needs to grasp two directions, one is standardization, and the other is innovation.

Professor Ma Fei explained that standardization refers to the homogenization and homogenization of breast cancer diagnosis and treatment across the country by standardizing breast cancer diagnosis and treatment, so that the overall urban-rural differences and regional differences can be further reduced, and the whole people can be guaranteed high-quality standards.
Treatment.

 Innovation is to narrow the gap between us and developed countries, continue to improve the effectiveness of breast cancer treatment, and continue to carry out double innovations in diagnosis and treatment models and methods.

For example, exploring a patient-centered comprehensive and full-cycle health management model.
And continue to develop new anti-tumor drugs to jointly promote the progress of breast cancer diagnosis and treatment.

"I believe that with our joint efforts, the overall level of breast cancer diagnosis and treatment will again be greatly improved in the future.

"※ Please note that the answers or content provided in this document may not contain all relevant information.

This content is for reference only and cannot replace the advice of doctors or other medical and health professionals.
Patients should not use this information for self-diagnosis Health or disease state.

Reference materials: [1] National Health Commission of the People’s Republic of China, Breast Cancer Diagnosis and Treatment Standards (2018 Edition).
Official website of the National Health Commission of the People’s Republic of China.
[2] Working Group of Guidelines for Women’s Breast Cancer Screening and Early Diagnosis and Treatment in China , Chinese Women's Breast Cancer Screening and Early Diagnosis and Treatment Guidelines (2021, Beijing).
Chinese Cancer.
2021.
30(3):161-191.
[3] National Cancer Center for Breast Cancer Expert Committee, etc.
, Chinese Advanced Breast Cancer Standards Diagnosis and treatment guidelines (2020 edition).
Chinese Journal of Oncology.
2020.
42(10):781-795.
[4] National Health and Family Planning Commission of the Expert Committee on Rational Use of Medicines, Guidelines for the Rational Use of Medicines for Breast Cancer.
ISBN: 9787117270700.
Expert profile Professor Ma Fei, National Cancer Center /Director of the Medical Treatment Center, Cancer Hospital, Chinese Academy of Medical Sciences, Secretary-General, National Committee for Clinical Application and Monitoring of Anti-tumor Drugs, Deputy Chairman, National Cancer Center, Breast Cancer Specialty Committee, and Secretary, National Cancer Center, Breast Cancer Screening and Early Diagnosis and Treatment Standards Committee Long Health China Action Promotion Committee, Incoming Expert, Chinese Pharmacist Association Oncology Specialist Pharmacist Branch Deputy Chairman, Chinese Anti-Cancer Association Integrated Oncology and Cardiology Branch Deputy Chairman, Chinese Anti-Cancer Association Multi-primary and Unidentified Primary Tumor Specialized Committee Deputy Chairman* This article is only used to provide scientific information to medical professionals and does not represent the views of this platform