What are the principles of chemotherapy for breast cancer?

Although both men and women have breasts, women are more likely to develop breast cancer. Among all breast cancer patients, 99% are women. Breast cancer is a very serious disease. Patients will experience many uncomfortable symptoms such as pain, and severe cases can directly endanger their lives. In fact, many people die from breast cancer every year. One treatment for breast cancer is chemotherapy.

1. Indications

It is currently believed that patients with positive axillary lymph nodes should be given postoperative adjuvant chemotherapy. Retrospective studies have shown that chemotherapy can reduce mortality in both premenopausal and postmenopausal patients. Research by the Early Breast Cancer Trialists Collaborative Group (EBCTCG), an internationally recognized breast cancer research organization, shows that chemotherapy not only prolongs the survival of premenopausal patients, but is also effective for postmenopausal breast cancer.

For patients with negative axillary lymph nodes, tumor diameter greater than 1 cm, estrogen receptor (ER) negative, histological grade III, vascular tumor thrombus and HER-2/neu positivity are all indications for postoperative adjuvant chemotherapy.

There is little data on adjuvant chemotherapy for breast cancer in patients over 70 years of age. Chemotherapy may also have a survival benefit, but toxicity should be considered, and concomitant diseases and non-cancer deaths will also affect the overall benefit.

2. Chemotherapy drugs and regimens

Effective single drugs for breast cancer chemotherapy include cyclophosphamide, fluorouracil, vinorelbine, anthracyclines (doxorubicin, epirubicin, pirarubicin), taxanes (paclitaxel, docetaxel), capecitabine, gemcitabine, etc. There are a variety of joint programs. A large number of studies have confirmed that multi-drug combination regimens are superior to single-drug regimens.

3. Starting time of adjuvant chemotherapy after breast cancer surgery

Although there is controversy over the best time to start chemotherapy for breast cancer, there is increasing support for early use of chemotherapy, even before surgery (see the chapter on neoadjuvant chemotherapy for details). In previous studies, chemotherapy was usually started 1 to 2 months after breast cancer diagnosis or surgery.

4. Duration of adjuvant chemotherapy after breast cancer surgery

A large number of studies have shown that the appropriate duration of adjuvant chemotherapy after breast cancer surgery is 4.6 cycles (3.6 months). For patients who choose two non-cross-resistant chemotherapy regimens, the chemotherapy cycle can be increased to 8 cycles. In special circumstances, chemotherapy should also be completed within 1 year after surgery.

5. The order of adjuvant chemotherapy and radiotherapy after breast cancer surgery

Some patients need to receive radiotherapy after modified radical surgery, and radiotherapy should be routinely performed after breast-conserving surgery. For a long time, there has been controversy over the order of chemotherapy and radiotherapy after breast cancer surgery. Supporters of radiotherapy first believe that it can improve local control rate, but delaying chemotherapy may affect distant metastasis and mortality. The consensus meeting on the development of adjuvant therapy for breast cancer held by the National Institutes of Health (NIH) in 2000 recommended that postoperative radiotherapy should be used within 6 months after surgery and should not be used simultaneously with chemotherapy containing anthracyclines.

VI. Reduction of toxic and side effects of adjuvant chemoradiotherapy after breast cancer surgery

Since the function of radiotherapy and chemotherapy drugs is to inhibit the DNA synthesis of rapidly proliferating tumor cells, which is commonly known as "cytotoxic effect", this causes radiotherapy and chemotherapy drugs to "not distinguish between friend and foe" and have a strong inhibitory effect on other rapidly dividing and proliferating cells in the body, such as bone marrow hematopoietic cells, gastrointestinal cells, immune cells, etc., thereby inhibiting tumor growth while producing serious toxic side effects. Clinical practice has proved that the combined use of radiotherapy and chemotherapy drugs with traditional Chinese medicine can improve the efficacy and reduce the toxic and side effects of radiotherapy and chemotherapy drugs.

At present, it is difficult to find patients who strictly follow the doctor's orders to use radiotherapy and chemotherapy alone. Many people use various Chinese medicines or health products with or without the doctor's knowledge to prevent and reduce the adverse reactions caused by chemotherapy and enhance its efficacy. Ganoderma lucidum is one of the most commonly used traditional Chinese medicines.

Clinical studies have shown that highly concentrated Ganoderma lucidum preparations (medical-grade Ganoderma lucidum spore powder) have a good synergistic therapeutic effect on tumors when used in combination with radiotherapy and chemotherapy. Its therapeutic efficacy is characterized by the following: reducing serious adverse reactions caused by chemotherapy, such as leukopenia, loss of appetite, weight loss, reduced anti-infection immunity, liver and kidney damage, and improving the tolerance of cancer patients to chemotherapy; improving the immune function of cancer patients, enhancing the body's anti-tumor immunity, enhancing the effect of chemotherapy, improving the quality of life of cancer patients, strengthening physical fitness, and prolonging survival.

It is currently believed that most breast cancer patients need chemotherapy, but there is insufficient evidence to find better postoperative adjuvant chemotherapy regimens for individual patients. Although large randomized clinical trials have shown that one regimen is superior to another, breast cancer is a highly heterogeneous disease and the same regimen may not be suitable for all cases. Therefore, a specific treatment plan needs to be developed based on your individual condition.