What is the
auxiliary treatment? How to choose the adjuvant treatment of breast cancer? I am hormone receptor (HR) masculine gender patient, after art must do 5 years of endocrine treatment? Will long-term medication after surgery lead to drug resistance? Today we are going to talk about “adjuvant therapy”. What I assist is not only surgery, but also the tree of life of patients. I call it adjuvant therapy. As the name implies, in the anti-cancer army, I am a role similar to a guard. As mentioned in previous tweets, if the fight against tumors is compared to *, and surgery is like a nest of charges launched against the nest of bandits (lesions), then my adjuvant treatment is carried out after surgery, aiming to eliminate the remaining “evil forces” (cancer cells) in the body and prevent the re-emergence of tumors. Some people will also call me an additional treatment, because I am a stable treatment method on the basis of the results achieved by surgical resection, just like an additional operation. In fact, what I assist is not only the curative effect of surgery, but also the long-term and stable survival of each patient! You know, surgery ≠ cure, breast cancer patients still have the risk of recurrence after surgery, 5 years after surgery or even the peak of recurrence. Therefore, although I am called an assistant, I am one of the indispensable partners for patients and friends to move towards the future! Breast cancer is a complex disease with different types, for different types of patients, I also have 18 kinds of martial arts, chemotherapy, targeted therapy, endocrine therapy, and even radiotherapy.. They are all my skillful moves. So how do I win because of the enemy? If you want to give full play to your greatest value, you need to choose the one that suits you. Breast cancer treatment needs to be precise and individualized. Patients with different types should choose different treatment methods, and patients with the same type have different treatment methods. Only by choosing the most suitable plan, can I play the greatest role in this adjuvant therapy! Taking the most common HR-positive breast cancer as an example, this type accounts for about 70% of all patients, whose cancer cell proliferation depends on the expression of estrogen/progesterone, in this case, endocrine therapy will be the key way to protect patients, that is, to reduce hormone production or inhibit the interaction between hormone and cancer cells through endocrine drugs. O as to achieve the purposes of inhibiting the proliferation of cancer cells and preventing recurrence and metastasis. Of course, for some patients with positive lymph node metastasis, or patients with Ki-67 ≥ 30% (representing rapid tumor proliferation), I can also use chemotherapy first, and then use endocrine therapy step by step. In general, endocrine therapy is the most important way for me to protect HR-positive breast cancer patients [1]. So what exactly did I do? According to the recommendation of the 2023 edition of the Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Breast Cancer [1], for postmenopausal patients with HR-positive breast cancer: if the risk of recurrence is high, I would prefer aromatase inhibitors (AI) combined with CDK4/6 inhibitors; If the patient is at low risk of relapse, I would prefer AI therapy, or switch to AI during the treatment period if the patient is on tamoxifen (TAM) first. It can be seen that for patients with high risk of recurrence, “I” will combine CDK4/6 inhibitors on the basis of endocrine drugs, because CDK4/6 inhibitors are a class of targeted drugs, which can selectively inhibit CDK4/6 kinase activity, thereby regulating cell cycle, inhibiting unlimited proliferation of cancer cells, and promoting the survival of cancer cells. Combined with endocrine therapy, it can produce synergistic effect and bring better therapeutic effect. Usually, the duration of endocrine therapy is 5 years, and if the patient has risk factors such as positive lymph nodes, G3 (representing a higher degree of malignancy), and the age of diagnosis is less than 35 years, it can also be considered to extend the duration of treatment. For premenopausal patients with HR-positive breast cancer, ovarian function is still very active, so it is necessary to combine ovarian function suppression (OFS) with postmenopausal treatment. 3 I will be a better self to give patients better adjuvant breast cancer treatment options need to be highly standardized, but standardized treatment is not static, in fact, breast cancer clinical researchers around the world are trying to find new strategies that can optimize existing treatment options. As mentioned above, endocrine drugs combined with CDK4/6 inhibitors are recommended for patients with HR-positive breast cancer at high risk of recurrence, while endocrine therapy alone is the first choice for patients at low risk of recurrence. How can we evaluate the risk of recurrence? The latest edition of the CSCO guidelines for the diagnosis and treatment of breast cancer considers HR-positive patients with ≥ 4 lymph node metastases or 1-3 lymph nodes with other risk factors as patients at high risk of recurrence who need to be recommended for combined targeted drug therapy. However, this does not mean that the recurrence risk of other early patients who do not meet this criterion can be completely prevented only by endocrine therapy. In fact, on the basis of endocrine therapy, even early breast cancer patients without lymph node metastasis still have a certain probability of recurrence. How to prevent recurrence earlier for patients and increase the chance of cure for more patients has always been a research topic that “I” want to seek a breakthrough day and night. Clinical research on adjuvant therapy for early breast cancer has been ongoing, and perhaps in the near future, the early standard therapy for HR-positive breast cancer will usher in a new change, when more patients will have a better survival. The infinite possibilities ahead are endless, so let’s wait and see! In fact, the choice of adjuvant therapy in real clinical practice is far more complicated than what we can explain in an article, and even between the same kind of drugs, the choice should be made according to the patient’s personal situation. For example, CDK4/6 inhibitors, which can be combined with endocrine drugs, have different clinical research performance and mechanism of action [2]. Therefore, breast cancer patients and friends must fully absorb the advice of clinicians, combined with their own situation, choose the most suitable auxiliary “guard”! 5 References References [1] Guideline Working Committee of Chinese Society of Clinical Oncology. Breast Cancer Diagnosis and Treatment Guidelines of Chinese Society of Clinical Oncology (CSCO) 2023 [M]. Beijing: People’s Medical Publishing House. 2023. [2] Kim S, et al. The potent and selective cyclin-dependent kinases 4 and 6 inhibitor ribociclib (LEE011) is a versatile combination partner in preclinical cancer models[J]. Oncotarget，2018，9（81）:35226-35240.
