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乳癌治療的療效與存活度相關性研究
Other Title
The Relationship Study Between the Treatment and Survival on
Breast Cancer Patients
Breast Cancer Patients
Type
thesis
Date Issued
2013-07-18
Author(s)
戴承正
Advisor
邱弘毅
Subjects
系所名稱：公共衛生學系暨研究所
Description
學位別：博士
語文別：英文
指導教授：邱弘毅
共同指導教授：吳志雄
口試委員：李飛鵬;沈志陽;楊俊毓;白其卉;許光宏
中文關鍵字：乳癌;化學治療;存活;標靶治療;成本
語文別：英文
指導教授：邱弘毅
共同指導教授：吳志雄
口試委員：李飛鵬;沈志陽;楊俊毓;白其卉;許光宏
中文關鍵字：乳癌;化學治療;存活;標靶治療;成本
Abstract
Abstract
Breast cancer is one of the most common cancers in advanced countries such as the UK, USA and Taiwan. This disease accounts for almost one-third of all cancers in women. In 2003, the age-standardized incidence rates per 100,000 population were 120.3 for England, 120.83 for Wales, 126.1 for all races in the USA and 49.19 for Taiwan. The high incidence of breast cancer in conjunction with the relatively good survival rates compared with many other cancers has led to a relatively high prevalence. Increasing age is the strongest risk factor for breast cancer, and the disease is rare in women under 40 years old. In Taiwan, the incidence in women under the age of 50 years is higher than that for those over 65 years old. Over 80% of cases occur in women over the age of 50 years in western countries, but less than 50% of these cases occur in the same group in Taiwan, with the number of diagnoses reaching a peak in the 50–65-year age group.
Breast cancer is classified into four clinical stages. Metastatic breast cancer (Stage IV) is characterized by the spread of distant metastases to other parts of the body, such as the bones, brain, lung or liver. Based on statistical analysis, fewer than 10% patients have been found to have stage IV disease at first diagnosis. Before the year 2000, approximately half of all women with breast cancer developed metastatic disease, although the majority had long disease-free intervals between treatment for early-stage breast cancer and the development of metastases. The treatment outcomes have considerably improved since 2000 in most advanced countries. However, this means that breast cancer should be treated as a systemic disease instead of a localized disease.
Treatments for metastatic breast cancer are primarily palliative rather than curative, although high rates of response can prolong survival to some extent. Toxicity and adverse effects therefore play important roles in treatment decisions, with quality of life being a key consideration.
Materials and Methods
Fifty-one women with a mean age of 46.9 years with HER-2-positive breast cancer who received adjuvant trastuzumab were included. Approximately 55% of the patients had stage III disease. The mean follow-up from initiation of treatment was 45.2 months (range, 0.9 to 85 months).
In the other study for advanced breast cancer patients, 20 patients were recruited at Taipei Medical University Hospital during 2005 to 2008. Bevacizumab was administered every two weeks in a 12-cycle treatment with docetaxel plus cisplatin. The primary end-point for this study was the overall response rate. The secondary end-points were progression-free survival and the safety profiles of the combined therapy.
Results
During follow-up in the adjuvant trastuzumab study, 46 patients of the 51 patients (90.2%) had no disease progression. The mean estimated disease- free survival was 80.2 months. The 1- , 2-, 5-, and 7-year estimated survival rates were 97.9%, 93.1%, 93.1%, and 93.1%, respectively. The most common adverse effects were gastrointestinal symptoms (21.6%), chills (17.6%), dizziness (9.8%), and bone pain (7.8%). No patients experienced cardiac or hematologic adverse events.
In the other study for metastatic breast cancer patients using bevacizumab plus docetaxel and cisplatin, the 20 enrolled patients had an average of 10.5 treatment cycles with a response rate of 80%. Neutropenia and neuropathy were the most commonly observed adverse events. Seven patients achieved complete remission and nine patients achieved partial remission. For all 20 patients in this study, the median time to progression and overall survival were 28.0 weeks and 52 weeks, respectively. The median time to progression and overall survival for the 10 patients who completed all 12 cycles of treatment were 64.0 weeks and 80 weeks, respectively. In one patient, a very rapid reduction in breast cancer lung metastases was observed one week post treatment.
Conclusions
It is always useful to judge individualized treatment outcomes in the disease management of patients. Lower costs do not always means poor outcomes. Treatment costs might be adjusted according to the gross domestic product of different nations, based on treatment burden considerations. Further studies with more patients are warranted.
Breast cancer is one of the most common cancers in advanced countries such as the UK, USA and Taiwan. This disease accounts for almost one-third of all cancers in women. In 2003, the age-standardized incidence rates per 100,000 population were 120.3 for England, 120.83 for Wales, 126.1 for all races in the USA and 49.19 for Taiwan. The high incidence of breast cancer in conjunction with the relatively good survival rates compared with many other cancers has led to a relatively high prevalence. Increasing age is the strongest risk factor for breast cancer, and the disease is rare in women under 40 years old. In Taiwan, the incidence in women under the age of 50 years is higher than that for those over 65 years old. Over 80% of cases occur in women over the age of 50 years in western countries, but less than 50% of these cases occur in the same group in Taiwan, with the number of diagnoses reaching a peak in the 50–65-year age group.
Breast cancer is classified into four clinical stages. Metastatic breast cancer (Stage IV) is characterized by the spread of distant metastases to other parts of the body, such as the bones, brain, lung or liver. Based on statistical analysis, fewer than 10% patients have been found to have stage IV disease at first diagnosis. Before the year 2000, approximately half of all women with breast cancer developed metastatic disease, although the majority had long disease-free intervals between treatment for early-stage breast cancer and the development of metastases. The treatment outcomes have considerably improved since 2000 in most advanced countries. However, this means that breast cancer should be treated as a systemic disease instead of a localized disease.
Treatments for metastatic breast cancer are primarily palliative rather than curative, although high rates of response can prolong survival to some extent. Toxicity and adverse effects therefore play important roles in treatment decisions, with quality of life being a key consideration.
Materials and Methods
Fifty-one women with a mean age of 46.9 years with HER-2-positive breast cancer who received adjuvant trastuzumab were included. Approximately 55% of the patients had stage III disease. The mean follow-up from initiation of treatment was 45.2 months (range, 0.9 to 85 months).
In the other study for advanced breast cancer patients, 20 patients were recruited at Taipei Medical University Hospital during 2005 to 2008. Bevacizumab was administered every two weeks in a 12-cycle treatment with docetaxel plus cisplatin. The primary end-point for this study was the overall response rate. The secondary end-points were progression-free survival and the safety profiles of the combined therapy.
Results
During follow-up in the adjuvant trastuzumab study, 46 patients of the 51 patients (90.2%) had no disease progression. The mean estimated disease- free survival was 80.2 months. The 1- , 2-, 5-, and 7-year estimated survival rates were 97.9%, 93.1%, 93.1%, and 93.1%, respectively. The most common adverse effects were gastrointestinal symptoms (21.6%), chills (17.6%), dizziness (9.8%), and bone pain (7.8%). No patients experienced cardiac or hematologic adverse events.
In the other study for metastatic breast cancer patients using bevacizumab plus docetaxel and cisplatin, the 20 enrolled patients had an average of 10.5 treatment cycles with a response rate of 80%. Neutropenia and neuropathy were the most commonly observed adverse events. Seven patients achieved complete remission and nine patients achieved partial remission. For all 20 patients in this study, the median time to progression and overall survival were 28.0 weeks and 52 weeks, respectively. The median time to progression and overall survival for the 10 patients who completed all 12 cycles of treatment were 64.0 weeks and 80 weeks, respectively. In one patient, a very rapid reduction in breast cancer lung metastases was observed one week post treatment.
Conclusions
It is always useful to judge individualized treatment outcomes in the disease management of patients. Lower costs do not always means poor outcomes. Treatment costs might be adjusted according to the gross domestic product of different nations, based on treatment burden considerations. Further studies with more patients are warranted.