The application value of ring drugs in different malignant tumors.

The ring drug is widely used in the treatment of tumor internal medicine and is a representative cytotoxic drug.
In the past few decades, although targeted drugs, immunotherapy drugs and other drugs for cancer treatment has brought new breakthroughs, but the ring drugs still in breast cancer, liver cancer and many other solid tumors and multiple myeloma (MM) and other blood system malignant tumor treatment plays an important role.
In order to explore the application value of cyclindrical drugs in breast cancer, liver cancer and multiple myeloma (MM) and other malignant tumors, Professor Huang Ping of the University of Chinese Academy of Sciences Affiliated Oncology Hospital, Professor Zhu Wei of the First Hospital affiliated with Zhejiang University Medical College and Professor Yu Chunxuan of zhejiang University School of Medicine were invited to share the topics of the initial treatment of the ring drug in breast cancer-assisted chemotherapy, the initial treatment of multiple myeloma (MM) and the choice of chemotherapy for advanced liver cancer.
in the treatment of breast cancer is still in the cornerstone position of the ring and yew drugs in the treatment of breast cancer are in the cornerstone position.
The treatment history of cyclic drugs is very long, EBCTCG meta-analysis shows that the standard AC scheme (doroubi star and cyclophosphamide) and CMF solution (cyclophosphamide and methotrexate plus 5-fluorourouracil) are equal in efficacy, and its use is more convenient, strengthen the cyclotherapy CAF/CEF program is superior to AC/CMF program, showing that the ring is more efficient chemotherapy for breast cancer.
currently believe that the study of the possibility of replacing the ring with yews alone is mainly the BIRG 006 and US Oncology 9375 trials.
The former was included in 3222 HER2-positive early breast cancer, randomly divided into AC-T, AC-TH and TCH 3 groups, the middle follow-up 65 months, chemotherapy combined H-programme treatment of disease-free survival (DFS) and total survival (OS) were significantly better than AC-T program, AC-TH program and TCH program efficacy no significant difference.
results show that the number of events in both AC-TH and TCH is low, which is not enough to compare the differences.
view of the survival curve, ac-TH scheme has a better trend than TCH scheme, and there is no reliable basis for the equivalent of TCH and AC-TH.
while the US Oncology 9735 study did confirm the effectiveness of the TC scheme, it only showed that the TC scheme was a good alternative and did not negate the effects of the ring joint yew scheme.
Although yew drugs and targeted therapy have greatly improved the effectiveness of breast cancer treatment, the current data are not sufficient to support the complete abandonment of the ring, a class of classic drugs with strong anti-breast cancer activity and controlled side effects.
especially in advanced breast cancer, for patients who have previously been treated with tyrion-type drugs, the re-use of tantalum-type drugs is also an important option in the event of the failure of yew-type drugs. The
-ring drug clinical experience CMF programme for breast cancer-assisted treatment is the first complementary chemotherapy programme to improve breast cancer survival, while the AC programme is simpler and shorter than the CMF programme (AC programme 4 cycles vs CMF programme 6 cycles), which is gradually widely accepted as the basis for early breast cancer treatment.
since the 1990s, yew drugs have gradually shown remarkable clinical efficacy, but most of them are combined or sequenal on the basis of the cyclindrical drug program.
CAF and CEF schemes, which have been commonly used in past programmes with cyclysic drugs, are currently commonly used, but there is no strict comparison between the two options.
there is no clear conclusion on the optimal course of chemotherapy with ring-containing drugs, and the course of treatment in different clinical studies is different.
clinicians can decide on treatment options based on evidence-based medical evidence, the risk of recurrence, and the patient's heart base.
the dose of the secondary chemotherapy programme should be as sufficient as possible, intensive treatment can be carried out under conditions, intensive treatment can bring about the survival benefits of patients.
can be used to collect medical history, detect liver and kidney function and electrolyte, evaluate heart function, and monitor heart function during use.
if intensive programmes are used, preventive use of elevated white blood cell medications and, if necessary, heart protection drugs.
, it is safer to use ring drugs clinically.
The clinical experience of cyclindrical drugs used in new ancillary treatment of breast cancer is also an important drug in the new auxiliary chemotherapy program for breast cancer, which can increase the rate of pathological complete remission (pCR), and similar to assisted chemotherapy, whether HER2 negative or HER2-positive breast cancer, the current new auxiliary chemotherapy is mostly combined or sequenated yew-containing drugs to increase the pCR rate.
the TEC scheme with ring-containing type has better survival results than the TC scheme without ring, and the pCR rate has a higher trend, especially in the three-negative breast cancer substation.
Although some of the current new complementary treatment studies have been tried without tyrides, such as INR2-positive breast cancer, the dual-targeted drug combined with purple shirt drugs, but may be mainly targeted therapy effect, and does not fully reflect the role of chemotherapy.
addition, for HER2-negative breast cancer, the long-term survival results are not yet mature.
combination of these two aspects, it shows that the new auxiliary chemotherapy completely abandons the ring drugs is not well-documented.
use of yews and tyrasses in the course of new complementary treatments is common and safe, even if the effectiveness and safety are fully assessed.
treatment of multiple myeloma (MM) retrospective multiple myeloma (MM) is the second most common malignant tumor in the blood system, accounting for about 10%.
mm incidence rate in China is increasing year by year, and the average age of onset is getting younger, in the past MM mainly occurs in the elderly patients.
latest statistics, the incidence of MM in China is 1.6/10,0000.
the development of MM treatment program, the overall can be divided into three stages: first, the traditional era of chemotherapy, followed by the era of hematopoietic stem cell transplantation, and finally, the era of new drugs.
the three eras were not completely separated, but connected through each other.
From the traditional mafaran combined glucocorticoids of the 1960s to strong chemotherapy in the 1980s and 1990s, to the emergence of new drugs such as boratezomi, salidamine, lynadamine, kafezome, Dara monotherapy, MM therapy has entered the era of targeted therapy.
due to the relatively short time to market in China, the availability and price advantage of new drugs is not as good as traditional chemotherapy.
with the improvement of health insurance policy year by year, domestic drug research and development, the current overall price of new drug treatment MM tends to be civilian, basically most people can afford.
current treatment options for boratezomi, lysozyme and desemethone are acceptable to most patients.
if the economy is in poor condition, other drugs may be considered.
MM's current treatment guidelines strategy is updated in conjunction with the current latest guidelines, the treatment principles and strategies for MM primary patients are mainly as follows: First, for asymptomatic MM patients, treatment is not recommended; Consider or enter clinical trials, for isolated plasma cell tumors, first consider the radiation treatment of the affected lesions, if the patient's clinical symptoms are not tolerated, such as excessive pain, can also consider surgical treatment, if progress into MM, then mm treatment plan.
MM patients with CLAB symptoms or SliM performance should consider initiating holistic treatment.
if the patient is younger than 65 years old, the physical condition is better, or although greater than 65 years old but the whole body is in good physical condition, induced treatment is effective, follow-up recommendations for self-hematopoietic stem cell transplantation.
the current first-line induction scheme is a joint immunomodant of protease inhibitors and a three-drug-based solution of desemeth.
induced treatment is effective and advocates early sequenal self-hematopoietic stem cell transplantation, especially for middle- and high-risk patients, more therapeutic significance.
stem cell mobilization is required before the transplantation of self-contained hematopoietic stem cells, which can be used in large doses of cyclophosphamide combined granulocyte stimulators or CXCR4 antagonists.
commonly used for pre-treatment is mafaran 140-200mg/m2.
for high-risk patients, a second transplant may be considered within 6 months of the first transplant.
whether the treatment needs to be consolidated after transplantation is currently controversial, and different strategies can be adopted according to the degree of risk after self-hematopoietic stem cell transplantation.
for high-risk patients, solid treatment can be carried out.
consolidation therapy generally uses the previous treatment effective program 2-4 courses after entering the maintenance treatment stage.
patients who do not have consolidation treatment can go directly to maintenance therapy.
for young patients with combined high-risk factors, heteroglytic hematopoietic stem cell transplantation may also be considered if there is a suitable provider.
patients who are not suitable for self-hematopoietic stem cell transplantation, it is recommended to continue using the induction scheme if it is effective and then enter maintenance therapy.
maintenance therapy can be used for nadamine, kapyzomi, Ishazomi, and even saliido amines.
high-risk patients, it is recommended to use a protease inhibitor to maintain treatment for 2 years or more, can also be used in a two-drug association.
but it is not recommended to use salicylamide alone as a maintenance treatment.
The chemotherapy program of advanced liver cancer chooses the application status of the treatment of liver cancer ANDE and the factors affecting the efficacy of TACE hepatocellular liver cancer (HCC) is one of the most common malignant tumors, most patients have been diagnosed in the middle and late stage, loss of treatment opportunities.
chemotherapy embolism (TACE) is the preferred treatment method for patients with middle- and late-stage liver cancer who cannot be surgically removed, and the efficacy is very clear.
according to the international authority of the Barcelona Clinical Liver Cancer Phase (BCLC), TACE is mainly used in patients with stage B of BCLC, some patients in the country are also receiving TACE treatment.
overall, TACE works well.
factors affecting the efficacy of TACE, the current promotion of precision embolism, TACE operator's operating techniques may affect the effectiveness of treatment.
, chemotherapy drugs and embolism materials may have an impact on treatment outcomes.
of treatment chemotherapy drugs for late-stage liver cancer in THEA, the application of chemotherapy drugs has played a very important role.
which chemotherapy drug for embolism can achieve better efficacy is often considered by clinicians.
the choice of chemotherapy drugs, each center has its own experience, there are differences in the choice.
but by far the most classic is table-to-table opioids such as Famaxin.
Of course, other drugs to choose from include fisciformin C, cisplatin, arsenic trioxide for injection, 5-fluorouracil (5-Fu), rittinase, hydroxyhicholine (HCPT) and so on.
at present, regardless of the chemotherapy options, including the table erythema and Osalipy platinum, the single-drug treatment plan is basically table soft than the star (such as Famaxin) mainly.
especially in drug-carrying micro-ball embolism (DEB-TACE), the carrier rate of table-soft drugs is higher, and the relative efficacy is better.
Professor Huang Ping, Deputy Director of Breast Oncology Medicine, University Of Chinese Academy of Sciences Affiliated Oncology Hospital (Zhejiang Cancer Hospital), Director of Oncology Medicine, Taizhou Hospital District of Zhejiang Cancer Hospital (Taizhou City Cancer Hospital), graduated from Zhejiang University with a seven-year major in Clinical Medicine.
is mainly engaged in the clinical work of breast cancer medicine, has a relatively rich experience in domestic and international clinical trials of new drugs, specializing in postoperative complementary standardized treatment of breast cancer and endocrine and targeted treatment of advanced breast cancer, as well as chemotherapy.
published several domestic core journals and SCI papers, presiding over 2 hall-level topics.
October 2016-March 2017 The Drug Review Center (CDE) of the State Food and Drug Administration was posted as a reviewer.
committee member of the Cancer Rehabilitation Professional Committee of Zhejiang Rehabilitation Medical Association.
Professor Zhu Wei, chief physician of the Department of Hematology of the First Hospital affiliated with Zhejiang University School of Medicine, is mainly engaged in the clinical diagnosis and treatment of malignant tumors in the blood system, and has participated in the research of several national and provincial natural science funds by publishing nearly 10 sci papers.
Professor Yu Chunxuan, Attending Physician of the Hepatobiliary Pancreatic Intervention Center of the First Hospital affiliated with Zhejiang University Medical College, Member of the Youth Committee of the Cancer Intervention Committee of Zhejiang Anti-Cancer Association, Doctor of Therapy at Cleveland Medical Center, USA, Professor Huang Ping: The status of anticholytic drugs in breast cancer-assisted chemotherapy.
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