乳癌的化學治療

針對早期乳癌，使用化學治療當作輔助性治療可以顯著減少復發及乳癌所導致的死亡，治療的新進展包括將紫杉醇（taxane）合併蒽環黴素（anthracycline）成為更有療效的處方，及發展多個基因及分子平台來預測早期乳癌病人的預後及輔助性化學治療的療效。經由許多臨床試驗，可依據療效強弱，將現今的輔助性化學治療分成第一、第二及第三代處方，經由基因及分子預測平台有助於病人及醫師挑選合適的治療。針對轉移性乳癌，已有許多具療效且較低毒性的化學藥物可以延長病人的存活並改善症狀，最近的新進展是研發這些藥物的最佳合併處方來增強療效及減少副作用。此外新藥如nanoparticle albumin-bound paclitaxel、ixabepilone 及eribulin mesylate 於近幾年來已被核准使用於轉移性乳癌，使病人有更多可用的藥物。本文章主要是針對化學治療於早期乳癌及轉移性乳癌的新進展進行回顧。

For early breast cancer, the use of adjuvant systemic therapy is responsible for the reduction in relapse and cause-specific mortality from breast cancer. The recent advances for early breast cancer treatment include the incorporation of taxanes to anthracycline as highly efficacious adjuvant chemotherapy regimen and development of genomic and molecular platform to predict outcome and benefit from adjuvant treatment. By the effort of many clinical trials, the current adjuvant chemotherapy regimens can be categorized to first, second and third generation regimens. With the development of prediction platforms, the patients and treating physicians can pick up the optimal treatment. For metastatic breast cancer, multiple chemotherapeutic agents exist that are active and tolerable for this patient population, leading to prolongation of survival and palliation of symptoms. Recent advances in chemotherpay have refined optimal combinations to enhance efficacy and minimize toxicity, and the addition of new agents, including nanoparticle albumin-bound paclitaxel, ixabepilone and eribulin mesylate have broadened the available selection of therapies. Herein, we review recent progress of chemotherapy use for early and metastatic breast cancer.