Current and Potential Chemotherapeutic Agents Used for Induction Chemotherapy in the Treatment of Breast Cancer

Ian   C.   Smith; Andrew   W.   Hutcheon; Steven   D.   Heys

doi:10.2174/1381612003401073

Abstract

A substantial proportion of breast cancers are large (greator than3 cm) or locally advanced (T 3 , T 4 , TXN 2 ) at the time of initial presentation. The therapeutic goals that must be achieved in patients with such cancers are to obtain adequate local disease control so that surgery can be performed and to abolish occult distant metastases therefore improving survival. Over the past three decades conventional adjuvant chemotherapy regimens have been employed pre-operatively (neo-adjuvant or primary chemotherapy) to achieve these goals. Studies have now shown that the survival of patients who receive neo-adjuvant chemotherapy is comparable to that of those who receive the same chemotherapy regimen following surgery. It is also apparent that although clinical tumour response rates to neo-adjuvant chemotherapy may be high there is considerable scope for improvement in the corresponding pathological tumour response. Furthermore, data from major studies that have comprehensively evaluated the use of pre-operative chemotherapy now indicates that the pathological response of breast cancers following treatment is of far greater prognostic importance than the clinical response. Recent interests has focoused, therefore, on the implementation of more prolonged or dose intensive chemotherapy regimens with the aims of improving pathological response to treatment and ultimately overall survival. Newer antineoplastic agents are also becoming available that may be used alone or in combination with conventional therapies in order that tumor response may be improved. This review describes current and potential therapeutic agents that may be used for the induction therapy of breast cancer.

Keywords: chemotherapeutic agents, induction chemotherapy, breast cancer, T3 T4 TXN2, anthracyclines, doxorubcin, streptomyces, epirubicin, alkylating agents, cyclophosphamide, acrolein, taxoids, paclitaxel Taxol, docetaxel, fluorinated pyrimidines, her 2 NEU THERAPY, endocrine therapy, anti oestrogens, toremifene, ralozifene, selective oestrogen receptor modulators SERMs, faslodex, exemestane, letrozole