Nabholtz J M, Tonkin K, Smylie M, Au H J, Lindsay M A, Mackey J
Northern Alberta Breast Cancer Program, Cross Cancer Institute, 11560, University Avenue, Edmonton, Alberta, T6G1Z2, Canada.
Expert Opin Pharmacother. 2000 Jan;1(2):187-206. doi: 10.1517/14656566.1.2.187.
Among the novel chemotherapeutic drugs introduced in the last decade, taxanes have emerged as the most powerful compounds and results available to date suggest that they will be remembered in the future as the breast cancer chemotherapy of the 1990s. The two taxanes (paclitaxel, Taxol, Bristol-Myers Squibb and docetaxel, Taxotere, Rhône-Poulenc Rorer) share some characteristics, but are also significantly different both in preclinical profile and, most importantly, in clinical characteristics. The main clinical differences are related to their different efficacy-toxicity ratio in relation to dose and schedule; the differing integrability of paclitaxel and docetaxel in anthracycline-taxane containing regimens, secondary to major differences in pharmacokinetic interactions between each taxane and the anthracyclines, and; the potential differences in level of synergism between each taxane and herceptin (HeR2Neu antibody/trastuzumab, Genentech/Roche). In clinical practice, the taxanes are now standard therapy in metastatic breast cancer after prior chemotherapy, in particular anthracyclines, has failed. Their role in combination with anthracyclines in first-line therapy of advanced breast cancer is emerging and sheds new light on the potential role of taxanes in the adjuvant setting. However, the impact of taxanes on the natural history of breast cancer is yet to be defined, despite the trend of results suggesting that these agents have the potential for significant improvements in advanced and, most importantly, adjuvant therapy of breast cancer. The results of all completed or ongoing Phase III trials in first-line metastatic and the adjuvant setting will help determine if taxanes will further improve the outcome of breast cancer or not.
在过去十年中引入的新型化疗药物中，紫杉烷类已成为最有效的化合物，目前可得的结果表明，它们在未来将作为20世纪90年代的乳腺癌化疗药物被铭记。两种紫杉烷类药物（紫杉醇，泰素，百时美施贵宝公司生产；多西他赛，泰索帝，罗纳-普朗克-乐仁堂公司生产）有一些共同特征，但在临床前特征方面，更重要的是在临床特征方面也存在显著差异。主要的临床差异与它们在剂量和给药方案方面不同的疗效-毒性比有关；紫杉醇和多西他赛在含蒽环类-紫杉烷类方案中的不同整合性，这是由于每种紫杉烷与蒽环类药物之间药代动力学相互作用的重大差异所致；以及每种紫杉烷与赫赛汀（Her2Neu抗体/曲妥珠单抗，基因泰克/罗氏公司生产）之间协同作用水平的潜在差异。在临床实践中，紫杉烷类药物现在是转移性乳腺癌在先前化疗（尤其是蒽环类药物）失败后的标准治疗方法。它们在晚期乳腺癌一线治疗中与蒽环类药物联合使用的作用正在显现，这为紫杉烷类药物在辅助治疗中的潜在作用提供了新的线索。然而，尽管结果趋势表明这些药物在晚期乳腺癌以及最重要的辅助治疗中有可能带来显著改善，但紫杉烷类药物对乳腺癌自然病程的影响尚未明确。所有已完成或正在进行的一线转移性和辅助治疗的III期试验结果将有助于确定紫杉烷类药物是否会进一步改善乳腺癌的治疗结果。
