Journal of Pharmaceutical Research

Open Access Open Access  Restricted Access Subscription Access

Chemoendocrine Metronomic Therapy of Estrogen Receptor-Positive Breast Cancer by Taxanes or Capecitabine in Combination with Aromatase Inhibitors


Affiliations
1 Breast Surgery Department, Cancer Center and Cancer Institute, Medical College, Fudan University, Shanghai, China
2 Institute of Chemical Engineering, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
 

The intense anticancer therapy using conventional cytostatic drugs is accompanied by serious side effects that restrict the application of the cytostatic drugs. Metronomic therapy as a modern method for administration of low doses of cytostatic agents that in combination with other anticancer drugs induce long lasting tumor dormancy with minimal side effects. Aim: We aimed our study at investigation of the efficacy of a contemporary chemoendocrine metronomic therapy, including cytostatic drugs, such as paclitaxel or capecitabine, in combination with aromatase inhibitors (AI, anastrozole, letrozole), in the treatment of estrogen recepor-positive breast cancer. Presentation of Case: The patient (74 years old) was initially diagnosed with advanced stage pT4bpN2Mx of infiltrative ductal breast carcinoma with lymph, lung and bone metastases. Discussion: Based on high estrogen receptor sensitivity in 67-100% of the analysed tumor cells, endocrine therapy was applied after mastectomy. However, progression of the disease required involvement of systemic cytostatic agents in the therapy. Following the achievements of the contemporary medicine, chemoendocrine metronomic therapeutical protocols, including combination of anastrozole with taxane or capecitabine, were found to induce rapid and continuous disease remission. Conclusion: This case report demonstrated rapid achievement of continuous remission by a contemporary chemoendocrine metronomic treatment of metastatic ER-positive breast cancer in all stages of the therapy: systemic anticancer treatment with weekly paclitaxel plus anastrozole, followed by anastrozole plus low doses of capecitabine and analogous maintenance therapy. The results can be explored in future clinical trials about synergy between hormone inhibitors and cytostatic agents in combination anticancer therapies.

Keywords

Anastrozole, Breast Cancer, Capecitabine, Chemoendocrine Metronomic Therapy, Paclitaxel.
User
Notifications
Font Size


  • Stewart BV and Wild CP. World Cancer Report 2014. World Health Organization Press, International Agency for Research on Cancer, Lyon, France; 2014. ISBN 978-92-832-0429-9.

  • Iqbal J, Abbasi BA, Mahmood T, Kanwal S, Ali B, Shah SA, Khalil AT. Plant-derived anticancer agents: a green anticancer approach. Asian Pacific Journal of Tropical Biomedicine. 2017; 7(12): 1129-1150.

  • Bertelsen C, Ji L, Garcia AA, Russell C, Spicer D, Sposto R. Efficacy of very-low-dose capecitabine in metastatic breast cancer. The American Journal of Hematology/Oncology Breast Cancer. 2015; 11(2): 20-30.

  • Sun JF, Wu RR, Norris C, Noone AM, Amankwa-Sakyi M, Slack R, Marshall JL. Safety of chronic low-dose capecitabine as maintenance therapy in gastrointestinal cancers. Gastrointestinal Cancer Research. 2009; 3(4): 134-140.

  • Montagna E, Cancello G, Dellapasqua S, Munzone E, Colleoni M. Metronomic therapy and breast cancer: a systematic review. Cancer Treatment Reviews. 2014; 40: 942-950.

  • Elzawawy S, Khedr G, Elsabaa B. Maintenance metronomic chemotherapy combined with conventional treatment for metastatic breast cancer patients. Korean Journal of Clinical Oncology. 2015; 11: 80-86.

  • Namer M, Fargeot P, Roché H, Campone M, Kerbrat P, Romestaing P, Monnier A, Luporsi E, Moncuquet P, Bonneterre J. Improved disease-free survival with epirubicin-chemoendocrrine adjuvant therapy compared with tamoxifen alone in one to three node-positive, estrogenreceptor-positive, postmenopausal breast cancer patients: results of French Adjuvant Study Group 02 and 07 trials. Annals of Oncology. 2006; 17: 65-73.

  • Brufsky AM. Long term management of patients with hormone receptor-positive metastatic breast cancer: Concepts for sequential and combination endocrine-based therapies. Cancer Treatment Reviews. 2017; 59: 22-32.

  • Bottini A, Generali D, Brizzi MP, Fox SB, Bersiga A, Bonardi S, Allevi G, Aguggini S, Bodini G, Milani M, Dionisio R, Bernardi C, Montruccoli A, Bruzzi P, Harris AL, Dogliotti L, Berruti A. Randomized phase II trial of letrozole and letrozole plus low-dose metronomic oral cyclophosphamide as primary systemic treatment in elderly breast cancer patients. Journal of Clinical Oncology. 2006; 24(22): 3623-3628.

  • Kataoka M, Yamaguchi Y, Moriya Y, Sawada N, Yasuno H, Kondoh K, Evans DB, Mori K, Hayashi SI. Antitumor activity of chemoendocrine therapy in premenopausal and postmenopausal models with human breast cancer xenografts. Oncology Reports. 2012; 27(2): 303-310.

  • This work was presented on the 4th International Mediterranean Symposium on Medicinal and Aromatic Plants (MESMAP-4), April 18-22, 2018, Antalya, Turkey, abstract book ISBN 978-605-61261-5-4, pg. 125.

  • Gibson L, Lawrence D, Dawson C, Bliss J. Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women. Cochrane Database of Systematic Reviews. 2009; 4: CD003370. http://dx.doi.org/10.1002/14651858.CD003370.pub3.

  • Eiermann W, Paepke S, Appfelstaedt J, Llombart-Cussac A, Eremin J, Vinholes J, Mauriac L, Ellis M, Lassus M, Chaudri-Ross HA, Dugan M, Borgs M. Letrozole Neo-Adjuvant Breast Cancer Study Group. Preoperative treatment of post menopausal breast cancer patients with letrozole: a randomized double blind multicenter study. Annals of Oncololy. 2001; 12: 1527-1532.

  • Ellis MJ, Coop A, Singh B, Tao Y, LLombart-Cussac A, Jänicke F, Mauriac L, Quebe-Fehling E, Chaudri-Ross HA, Evans DB, Miller WR. Letrozole inhibits tumor proliferation more effectively than tamoxifen independent of HER1/2 expression status. Cancer Research. 2003; 63: 6523-6531.

  • Cserni G. “Revertant” mammary solid papillary carcinoma in lymph node metastasis. Pathology Oncology Research. 2002; 8(1): 74-77.

  • Once a week during therapy 250 g of red beetischolar_main (Beta vulgaris L.), known in the folk medicine as antioxidant, strengthening renewal of the red blood cells, was given as a fresh juice together with the juice of 200 g carrots, an orange and an apple.

  • Perez EA. Impact, mechanism, and novel chemotherapy strategies for overcoming, resistance to anthracyclines and taxanes in metastatic breast cancer. Breast Cancer Research and Treatment. 2009; 114: 195-201.


Abstract Views: 399

PDF Views: 81




  • Chemoendocrine Metronomic Therapy of Estrogen Receptor-Positive Breast Cancer by Taxanes or Capecitabine in Combination with Aromatase Inhibitors

Abstract Views: 399  |  PDF Views: 81

Authors

Jian-wei Li
Breast Surgery Department, Cancer Center and Cancer Institute, Medical College, Fudan University, Shanghai, China
Xiao-qing Jia
Breast Surgery Department, Cancer Center and Cancer Institute, Medical College, Fudan University, Shanghai, China
Diana Ivanova
Institute of Chemical Engineering, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria

Abstract


The intense anticancer therapy using conventional cytostatic drugs is accompanied by serious side effects that restrict the application of the cytostatic drugs. Metronomic therapy as a modern method for administration of low doses of cytostatic agents that in combination with other anticancer drugs induce long lasting tumor dormancy with minimal side effects. Aim: We aimed our study at investigation of the efficacy of a contemporary chemoendocrine metronomic therapy, including cytostatic drugs, such as paclitaxel or capecitabine, in combination with aromatase inhibitors (AI, anastrozole, letrozole), in the treatment of estrogen recepor-positive breast cancer. Presentation of Case: The patient (74 years old) was initially diagnosed with advanced stage pT4bpN2Mx of infiltrative ductal breast carcinoma with lymph, lung and bone metastases. Discussion: Based on high estrogen receptor sensitivity in 67-100% of the analysed tumor cells, endocrine therapy was applied after mastectomy. However, progression of the disease required involvement of systemic cytostatic agents in the therapy. Following the achievements of the contemporary medicine, chemoendocrine metronomic therapeutical protocols, including combination of anastrozole with taxane or capecitabine, were found to induce rapid and continuous disease remission. Conclusion: This case report demonstrated rapid achievement of continuous remission by a contemporary chemoendocrine metronomic treatment of metastatic ER-positive breast cancer in all stages of the therapy: systemic anticancer treatment with weekly paclitaxel plus anastrozole, followed by anastrozole plus low doses of capecitabine and analogous maintenance therapy. The results can be explored in future clinical trials about synergy between hormone inhibitors and cytostatic agents in combination anticancer therapies.

Keywords


Anastrozole, Breast Cancer, Capecitabine, Chemoendocrine Metronomic Therapy, Paclitaxel.

References