Vishnu Prakash, Roy Vivek
Mayo Clinic, Division of Hematology Oncology, Jacksonville, FL, USA.
Womens Health (Lond). 2010 Jul;6(4):495-506. doi: 10.2217/whe.10.42.
Breast cancer is the most common type of cancer diagnosed in women. Anthracyclines and taxanes are the most active and widely used chemotherapeutic agents in the treatment of both early-stage and advanced breast cancer. In the past decade, novel formulations of these cytotoxic agents have been developed to improve efficacy and decrease toxicity. nab-paclitaxel is a solvent-free, albumin-bound 130-nm particle form of paclitaxel (Abraxane, Abraxis Bioscience, CA, USA), which was developed to avoid toxicities associated with the Cremophor vehicle used in solvent-based paclitaxel. In a Phase III study, nab-paclitaxel demonstrated higher response rates, a better safety profile compared with conventional paclitaxel, and improved survival in patients receiving it as second-line therapy. Based on this pivotal trial, nab-paclitaxel is now approved in the USA for treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant therapy where prior therapy included an anthracycline unless clinically contraindicated. Recently, several Phase II studies have suggested a role for nab-paclitaxel as a single agent and in combination with other agents for first-line treatment of metastatic breast cancer. Studies are ongoing to explore the use of nab-paclitaxel in other solid tumors such as non-small-cell lung cancer, ovarian cancer and malignant melanoma.
乳腺癌是女性中最常被诊断出的癌症类型。蒽环类药物和紫杉烷类药物是治疗早期和晚期乳腺癌最有效的且应用最广泛的化疗药物。在过去十年中,已开发出这些细胞毒性药物的新型制剂以提高疗效并降低毒性。纳米白蛋白结合型紫杉醇是一种无溶剂、与白蛋白结合的130纳米颗粒形式的紫杉醇(商品名:Abraxane,美国加利福尼亚州Abraxis Bioscience公司生产),其研发目的是避免与溶剂型紫杉醇中使用的聚氧乙烯蓖麻油载体相关的毒性。在一项III期研究中,纳米白蛋白结合型紫杉醇显示出更高的缓解率,与传统紫杉醇相比安全性更好,并且在接受二线治疗的患者中提高了生存率。基于这项关键试验,纳米白蛋白结合型紫杉醇目前在美国被批准用于治疗转移性疾病联合化疗失败或辅助治疗6个月内复发的乳腺癌,前提是先前治疗包括蒽环类药物,除非有临床禁忌。最近,几项II期研究表明纳米白蛋白结合型紫杉醇作为单一药物以及与其他药物联合用于转移性乳腺癌一线治疗的作用。正在进行研究以探索纳米白蛋白结合型紫杉醇在其他实体瘤中的应用,如非小细胞肺癌、卵巢癌和恶性黑色素瘤。