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Advanced breast cancer without chemotherapy? Experts answer your questions to many breast cancer patients, especially those with advanced breast cancer. They often have a question, “If you have advanced breast cancer, you can choose other treatment options without chemotherapy.” So, if you have breast cancer, you must have chemotherapy? Is “no chemotherapy” an option? Xiao Bian invited experts in breast cancer in China. Director Shi Yanxia, ​​chief physician of the Department of Oncology, Sun Yat-sen University Cancer Hospital, today will share with us the knowledge about the choice of advanced breast cancer without chemotherapy. In fact, Director Shi Yanxia suggested that there is still a lot of treatment options for advanced breast cancer even if you do not choose chemotherapy. However, patients with advanced breast cancer ask themselves if they can “chemotherapy” or “no chemotherapy”. First, ask yourself a few questions: First, the doctor told me that I have to “make chemotherapy”? Second: What is the most worrying about chemotherapy or me or my family? Third: If you choose to use other treatments without chemotherapy, will the effect be better and the side effects be lower? First: The doctor told me that I have to “must” chemotherapy? In fact, chemotherapy or no chemotherapy is not an inevitable choice for doctors, or it can be decided at random. For patients with advanced breast cancer, the doctor will develop a suitable treatment plan for each person’s specific type of breast cancer, the individual’s body, age, and condition. Among them, patients with a considerable number of cases can start without chemotherapy. In most cases, if breast cancer tumors have multiple metastases and rapid growth, chemotherapy is one of the options to help control tumors quickly. Of course, the side effects and quality of life may have a greater impact. A few patients even Unbearable, and therefore put forward “is it possible not to chemotherapy?” But in fact, chemotherapy is only a treatment plan, not all patients with advanced chemotherapy must be treated at the beginning, and doctors will not recommend to all patients that chemotherapy is necessary from the beginning. For example, if you have a pathological examination of a tumor, the report contains two items, ER and PR. One of the indicators is indicated by a “+” sign in parentheses, indicating that the tumor cells belong to a special type of breast cancer, ie Hormone receptor-positive breast cancer. If your breast cancer tumor belongs to this type, tumor growth is not particularly rapid. In fact, the attending doctor will recommend a more “moderate” regimen of “endocrine therapy” according to the guidelines of the Chinese Society of Clinical Oncology. It can help control tumors, and its side effects are more tolerated than traditional chemotherapy. This is the common choice for breast cancer without chemotherapy. In general, the drugs commonly used by doctors are a class of drugs called “aromatase inhibitors”, such as letrozole, anastrozole, and exemestane. If you have used endocrine therapy before, you may also consider fluvitics. Groups and other drugs. Of course, breast cancer endocrine therapy, although not chemotherapy, itself can cause some side effects, mainly due to some similar peri-menopausal symptoms caused by hormone blockade. Now, with the new technological breakthroughs, based on endocrine therapy, a new class of targeted drugs can be added. These targeted drugs are called “CDK4/6 inhibitors”, and studies have shown that these inhibitors combined with endocrine therapy can help some patients with newly diagnosed advanced breast cancer to prolong tumor control for more than 2 years, and also write in China. In the treatment guidelines for external breast cancer, in terms of efficacy, it is a more reasonable choice than all aspects of traditional chemotherapy. At present, only one of these targeted drugs has been marketed in China, which is Pirsili (also known as Ibrance) produced by Pfizer. This drug only needs to be taken 1 day during endocrine therapy for breast cancer. After taking it for 3 weeks and stopping for 1 week, it can help better control the tumor. This “no chemotherapy” treatment program, its advantage is that it does not need to go to the hospital for regular infusion like chemotherapy, or other intravenous drug-targeted drugs, it requires long-term intravenous infusion tube, which causes great damage to daily life and care. Trouble, its side effects are also much lower than in the traditional sense of chemotherapy. Moreover, the longer the tumor is controlled, the longer the time required for chemotherapy may be further delayed. In the future, new regimes that do not require chemotherapy may continue to be used.Second: What is the most worrying about chemotherapy or me or my family? For advanced breast cancer, many patients and their families may have the biggest concern about chemotherapy, which is side effects. This is also the main reason why many patients have suggested that they can not “no chemotherapy.” Director Shi Yanxia pointed out: For chemotherapy, it has always been the existence of “demonization” in everyone’s mind, not only the side effects are large, but many people may also be “dead.” But in fact, the treatment of cancer has been developed for so many years, not only the “no chemotherapy” program such as Aiboxin combined with endocrine therapy, but the chemotherapy itself is constantly improving and improving. Scientists have been looking for chemotherapy regimens for advanced breast cancer with fewer side effects and better efficacy, as well as aggressive prevention and control measures for the side effects of chemotherapy, and will choose different for each patient’s physical condition and needs. Dosage or toxic chemotherapy regimen to ensure a reasonable balance between efficacy and quality of life. “No chemotherapy” is certainly a patient’s expectation, but chemotherapy is not a terrible choice. Chemotherapy is still very important for the treatment of advanced breast cancer in many cases. Even new drugs such as Aiboxin may not be replaced. For example, some types of breast cancer currently rely on chemotherapy to control tumors. Some types of breast cancer, although targeted drugs, still require combination chemotherapy. Because in the case of combination therapy, the control of the condition is more effective. Some types of advanced breast cancer seem to use endocrine therapy, as well as a new drug, Aiboxin, but if the tumor progresses rapidly and endocrine drugs are uncontrollable, chemotherapy is still needed to help control. Over the years, with the optimization of chemotherapy regimens and the management of related toxicity sciences, the side effects have been well controlled. Although regular infusions to the hospital can cause some troubles, many patients can still maintain a better quality of life in the chemotherapy interval. Therefore, you can’t refuse chemotherapy because of fear, and only look for the “no chemotherapy” program. To follow more doctor’s advice, follow the advice of doctors and experts. Third: Is it not chemotherapy, it means better efficacy and lower side effects? In many tumors, such as lung cancer, there are indeed side effects of targeted therapies that are less than chemotherapy and that control tumors for longer. But not all tumors are the same. Chemotherapy is still important in breast cancer patients, especially in advanced breast cancer. Even hormone receptor-positive breast cancers may sometimes require chemotherapy. As we mentioned above, Aiboxin, as a new hormone receptor-positive targeted drug, has not been directly compared with chemotherapy, nor does it mean that it is the only direction of “no chemotherapy”; just because of this Tumor-like patients do not need chemotherapy at first, only endocrine therapy is needed. On the basis of endocrine therapy, Aiboxin combined with endocrine therapy can prolong the time of tumor control. Of course, even if the disease needs chemotherapy after the disease progresses, the time is delayed for a while. At the same time, Aiboxin is a new targeted drug for cancer treatment. It also has side effects. Common side effects include neutropenia, infection, stomatitis, anemia, diarrhea, alopecia, thrombocytopenia, rash, vomiting, loss of appetite, Powerless and hot. However, most of the side effects are usually mild and can be well controlled by home care and close monitoring by the doctor. In addition, the immunotherapy that everyone often hears is also a choice of “no chemotherapy”, which has a large-scale application in many tumors with its good curative effect and lower side effects. Unfortunately, there is currently no valid evidence for advanced breast cancer patients, nor is it recommended as a treatment for most patients in breast cancer treatment guidelines. There are a number of corresponding immunotherapy clinical trials in patients with advanced subtypes of advanced breast cancer, and clinical trials can be considered if one considers this type of treatment. This is another breakthrough direction of “no chemotherapy”.Most importantly, in the process of communication with the doctor, whether you are a patient or a patient, there is concern about chemotherapy. For the idea of ​​not wanting chemotherapy, be sure to communicate with your doctor: 1. My breast cancer What is the current stage? What is the specific transfer? 2. What type of breast cancer does it belong to? 3. Based on the current situation, what is the treatment plan available? 4. What effect can these treatments achieve? What are the side effects? 5. What should I do if there are side effects during treatment? Can I communicate or contact the doctor directly? 6. How often does it take to review during treatment? How to judge the effectiveness of treatment? 7. In view of the current situation, is there any new drug available at home and abroad? If so, what are the effects and side effects of the new drug? 8. Is there a clinical trial that can be recommended? For the treatment of advanced breast cancer, whether chemotherapy or “no chemotherapy”, or new drugs or clinical trials, the purpose of these treatments is to better control the tumor, and on this basis, enable patients to Have a better life treatment and prolong survival. When considering the treatment, patients and their families, whether they choose chemotherapy or not, need to communicate carefully with the doctor to understand their situation and choose the most appropriate treatment. Can not blindly refuse chemotherapy, but can not be treated with ignorance. Shi Yanxia, ​​female, deputy chief physician, received a doctorate in oncology from Sun Yat-sen University in 2004. Mainly engaged in professional: tumor chemotherapy and biological therapy, especially in breast cancer, nasopharyngeal cancer, head and neck cancer, digestion, lung cancer and other tumors have rich experience. The main research directions: 1, targeted therapy of breast cancer: anti-her-2 resistance mechanism; 2, tumor immunosuppressive mechanism: the mechanism of Treg cells in tumor immunosuppression and Treg cell-targeted immunity Therapeutic application in lymphoma, etc.; the role of complement immunosuppression in breast cancer, lymphoma and immunotherapy targeting complement C5A. He has published more than 10 papers in domestic and foreign journals, presided over a number of national, provincial and municipal research projects, and was funded by the Sun Yat-sen University Cancer Hospital Excellent Talents Program. Participated in the preparation of “Tumor Biotherapy” (Guangdong Science and Technology Press, December 2005), and participated in a number of clinical research on new anti-tumor drugs. References: 1. China Society of Clinical Oncology (CSCO) Breast Cancer Treatment Guide (2018 edition) 2. National Comprehensive Cancer Network (NCCN) Breast Cancer Treatment and Treatment (2018 V2.0) 3. Aiboxin (Pebrixili Capsules) ) instructions.

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