Acne and its treatment options: a review

Acne vulgaris is an extremely common condition affecting more than 80-90% of adolescents and young adults. It typically starts in late childhood or early teens, but onset may be delayed in some people well into their 20s and 30s. The incidence rate of acne is roughly the same in males and females but, males tend to have more serious conditions. Common therapies that are used for the treatment of acne include topical, systemic, herbal and combination therapies. This review is an attempt to trace out the causes of acne, to know its treatment options and precautions to be taken to prevent it.     

Triple negative breast cancer chemosensitivity and chemoresistance: current advances in biomarkers indentification

Introduction: Triple negative breast cancer (TNBC) is a heterogeneous clinicopathological entity constituting approximately 15 – 20% of all breast cancer (BC) patients. It shows high recurrence rate and poor prognosis. At this juncture, because of the lack of specific targeted therapies available and the development in patients of resistance to some therapeutic agents, clinical and translational settings have gained importance over the past decades. Areas covered: The development of novel, safe and effective alternatives for the treatment of TNBC are in high demand. Therefore, this review aims to summarize the state of the art of TNBC, its current therapies and potential therapeutic targets. In particular, focus is put on recent advances regarding the identification of emerging biomarkers as prognostic and/or predictive markers, including surrogate markers for molecular tumor subtyping and identifying potential responders to new therapies. Expert opinion: Effective development of informative markers could constitute an important armamentarium tool for identifying appropriate therapies to challenge the aggressiveness of TNBC.     

乳腺恶性肿瘤手术方式探讨

乳腺癌是严重威胁女性身心健康的恶性肿瘤之一,国内主流术式根治性乳房切除术可以大大降低乳腺癌死亡率。保乳手术在肿瘤治疗基础上兼顾乳房外形和患者心理,乳房肿瘤整形术通过将整形技术应用于乳腺肿瘤手术的诸多环节从而获得更显著的美学效果,两者在国内均有很大的发展空间,术式选择应当更加理性和乐观。     

Early stage breast cancer: treatment options and results.

Large randomized clinical trials have redefined patterns of spread which have major implications for treatment options and outcomes in early stage breast cancer. Trials comparing mastectomy plus radiotherapy with mastectomy alone in women with T1-2 N0-1 M0 disease show clearly that the probability of developing distant metastases is unaffected by treatment of the lymphatic pathways. The inference is that, for the vast majority of women presenting with early stage disease, the cancer is either confined to the breast or else disseminated via vascular and lymphatic channels more or less simultaneously. Breast cancer is almost unique in that distant metastases may remain occult for several decades before becoming clinically apparent by mechanisms which remain unclear. The probability of haematogenous dissemination correlates closely with tumour size and this observation is the basis of population-based screening programmes discussed elsewhere in this issue. By identifying tumours earlier in their evolution, effective treatment of the primary disease is expected to be curative in a greater proportion of women. The implications for breast conserving management of women with early stage breast cancer are that initial surgery and radiotherapy must be of a high quality and promptly delivered if the expected reductions in breast cancer mortality are to materialize.     

CNS complications of breast cancer: current and emerging treatment options

In general, the development of CNS metastases of breast cancer depends on several prognostic factors, including younger age and a negative hormone receptor status. Also, the presence of a breast cancer 1, early onset (BRCA1) germline mutation and expression of the human epidermal growth factor receptor 2 (Her2/neu) proto-oncogene seem to contribute to an increased rate of development of CNS metastases.The choice of appropriate therapy for brain metastases also depends on prognostic factors, including the age of the patient, the Karnofsky performance score, the number of brain metastases and the presence of systemic disease. Surgery followed by whole brain radiation therapy (WBRT) is generally restricted to ambulant patients with a single brain metastasis without active extracranial disease. In patients who have two to four metastases, stereotactic focal radiotherapy (i.e. radiosurgery) with or without WBRT is usually indicated. In the remainder of patients, WBRT alone provides adequate palliation. Although breast carcinoma is sensitive to chemotherapy, the role of chemotherapy in the treatment of brain metastases is still unclear. Objective responses after cyclophosphamide-based therapies were reported in studies performed in the 1980s. Subgroup analysis of data from a randomised study indicates that survival may improve if WBRT is combined with the radiosensitiser efaproxiral. Interestingly, the Her2/neu antibody trastuzumab, which does not cross the blood-brain barrier, produces systemic responses and enhanced survival, without a clear effect on brain metastases.Breast cancer constitutes the most common solid primary tumour leading to leptomeningeal disease. Clinical symptoms such as cranial nerve dysfunction or a cauda equina syndrome can be treated with local radiotherapy. A randomised study in patients with leptomeningeal disease secondary to breast cancer has revealed that intrathecal chemotherapy is associated with substantially more adverse effects than non-intrathecal treatment, without a clear benefit in terms of response or survival.Intramedullary metastasis is rare but often presents with a rapidly progressive myelopathy. Local radiotherapy may preserve neurological function.Epidural spinal cord metastasis occurs in approximately 4% of patients and can lead to paraplegia. A randomised study has shown that surgical intervention together with local radiotherapy is superior to local radiotherapy alone.     

Chemoprevention of cancer: a brief review

Chemoprevention of cancer can react on simple measures, such as eliminating exposures, to using complicated molecular structures in patients. Over the long term, avoiding tobacco use and eating a diet high in fruits, vegetables and whole grains are relatively effective personal means to prevent cancer.     

三阴性乳腺癌患者的临床特点及预后分析

目的分析三阴性乳腺癌患者的临床特点及其预后的相关因素。方法收集1998年1月1日～2008年12月31日汕头大学医学院附属肿瘤医院收治的712例原发性乳腺癌女性患者的临床资料,经免疫组化检查证实ER、PR和HER2/neu均为阴性的三阴性乳腺癌144例（20.2%）。回顾性分析三阴性乳腺癌患者的临床特点及其生存预后等情况。采用χ2检验进行单因素分析,Kaplan-Meier法计算生存率。结果本组病例中有20.2%（144/712）为三阴性乳腺癌,多见于有恶性肿瘤家族史者,而与患者年龄、肿瘤大小、淋巴结情况无明显关系。截至2009年10月31日,144例三阴性乳腺癌患者中位随访时间为26个月（2～147个月）,有57例患者出现复发及转移,38例已死亡。三阴性乳腺癌组局部复发率及骨、脑转移发生率与非三阴性乳腺癌（non triple-negative breast cancer,Non-TNBC）组患者相比并未发现显著性差异,但三阴性乳腺癌患者肺、肝转移发生率明显高于非三阴性乳腺癌。生存分析显示,三阴性乳腺癌患者的2、5、10年无病生存率分别为71.1%%、58.2%和53.7%,总生存率分别为80.8%、66.5%和55.2%。结论三阴性乳腺癌约占所有原发性乳腺癌中1/5。这些患者以伴有恶性肿瘤家族史、容易发生内脏转移及总生存率低为主要特点,而与患者年龄、肿瘤大小、淋巴结情况无明显关系。伴有恶性肿瘤家族史、容易出现肺转移和肝转移可能与该器官表达某些特异性受体有关,也可能是导致三阴性乳腺癌预后较差的重要原因。     

Hyperpigmentation: a review of common treatment options

Hyperpigmentation disorders are common and include a multitude of forms. They are typically divided into three large categories: dermal, epidermal, or mixed, depending on the site of abnormality. The location of the increased melanin affects treatment options, but therapy within a group is often similar. This paper discusses the treatment modalities, including topical and surgical approaches, available for the different types of hyperpigmentation.     

Docetaxel: a review of its use in metastatic breast cancer

Docetaxel (Taxotere), a cytotoxic taxane, is an antimicrotubule agent effective in the treatment of patients with breast cancer. The clinical profile of docetaxel as an effective cytotoxic agent in the treatment of metastatic breast cancer is well established. As yet, no single standard regimen has been identified as optimal for the treatment of patients with metastatic breast cancer after failure of prior chemotherapy. However, the efficacy of docetaxel monotherapy administered every 3 weeks as a 1-hour infusion is similar to or better than that of doxorubicin, paclitaxel and fluorouracil plus vinorelbine, and better than that of methotrexate plus fluorouracil or mitomycin plus vinblastine. Although docetaxel is associated with neutropenia and other adverse events, its overall tolerability profile is generally acceptable in the majority of patients. Docetaxel, therefore, is an effective option in the treatment of patients with metastatic breast cancer after failure of prior chemotherapy.     

Clodronate: a review of its use in breast cancer.

Like other members of its class, the bisphosphonate clodronate (clodronic acid) inhibits bone resorption. The efficacy of oral clodronate 1600 mg/day in reducing the incidence of skeletal complications and metastasis development has been assessed in several clinical trials in patients with breast cancer. Long term use of oral clodronate significantly reduced the total cumulative incidence of skeletal events (including fractures, hypercalcaemia, and the need for radiotherapy for bone pain) compared with that in placebo recipients in 2 randomised double-blind placebo-controlled studies, each involving >100 patients. Significant differences in favour of clodronate were also seen in the frequency of some individual skeletal events in 1 trial. A nonblind trial in 302 patients considered to be at high risk of developing metastases found that, at a 3-year follow-up, significantly fewer patients who received clodronate for 2 years developed skeletal metastases than those in a control group. Clodronate recipients were also significantly less likely than controls to develop visceral metastases, and had significantly higher survival rates. A smaller double-blind placebo-controlled study in women with recurrent breast cancer found that clodronate significantly decreased the total number of new skeletal metastases, but not the number of patients who developed them. In a nonblind trial in 299 patients with node-positive breast cancer, however, the incidence of skeletal metastases did not differ significantly between patients who received clodronate for 3 years and those in a control group. In addition, clodronate recipients had a significantly greater incidence of nonskeletal metastases (local and visceral), and significantly lower survival rates. Intravenous or oral clodronate has been well tolerated in clinical trials. The most common adverse effects reported were mild gastrointestinal disturbances such as nausea, vomiting and diarrhoea. All these events were transient, and usually resolved without stopping treatment. Conclusions: Clodronate is a well tolerated bisphosphonate, available in both oral and intravenous forms, that significantly reduces the incidence of skeletal complications associated with breast cancer. Further research is needed to establish more clearly its efficacy in reducing metastasis development, to assess its efficacy compared with other bisphosphonates, and to determine which patients will benefit most from treatment. Currently, clodronate is probably most effective in the treatment and prevention of general skeletal complications in patients with breast cancer.     

Pertuzumab for the treatment of breast cancer: a safety review

ABSTRACT

Introduction: Approximately twenty to thirty percent of newly diagnosed breast cancers are human epidermal growth factor receptor 2 (HER2) positive. The use of trastuzumab, and more recently pertuzumab, has significantly improved the progression free survival (PFS) and overall survival (OS) in this patient population. However, pertuzumab has side effects that can impact treatment tolerability and quality of life.

Areas covered: This review describes the safety and tolerability of pertuzumab, a monoclonal antibody targeted at HER2 approved by the United States Food and Drug Administration (FDA) for use in the neoadjuvant and first line metastatic settings.

Expert opinion: The combination of trastuzumab, pertuzumab, and chemotherapy is approved in the neoadjuvant and first line metastatic settings and should be strongly considered by providers. Further studies are needed to look at side effect prevention, novel pertuzumab containing regimens, and re-treating patients with pertuzumab.     

Atopic dermatitis: a review of topical treatment options

Abstract

Background:

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with a wide range of severity, and is usually the first manifestation of atopic disease. It is one of the most common skin disorders in developed countries, affecting approximately 20% of children and 1–3% of adults. Symptoms such as eczematous papules, plaques, and itch, and their associated consequences, such as sleep disturbance, can significantly impact the quality of life of the patient and family.     

Controlling sialorrhoea: a review of available treatment options

Sialorrhoea (drooling or excessive salivation) is a common symptom of many neurological diseases (e.g., amyotropic lateral sclerosis, cerebral palsy and Parkinson's disease) and otolaryngologic diseases (tumours of upper aerodigestive tract). It is mostly caused by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea). However, some cases of sialorrhoea are due to hypersecretion of saliva. These cases represent so-called primary sialorrhoea.     

Pityriasis versicolor: a review of pharmacological treatment options

Pityriasis versicolor is a common disorder of the skin, which is characterised by scaly hypo- or hyperpigmented lesions on the body. The lipophilic yeast, Malassezia, is considered to be the aetiological agent of this disease. A number of treatment options, both topical and systemic, have been shown to be effective. A critical evaluation of treatment options is presented.     

Ibandronic acid: a review of its use in the treatment of bone metastases of breast cancer

Ibandronic acid (Bondronat) is a potent, new-generation, nitrogen-containing bisphosphonate, available in both intravenous and oral formulations, which effectively inhibits osteoclast-mediated bone resorption. In clinical trials, the two formulations were equally effective in preventing skeletal-related events and improving quality of life in patients with bone metastases of breast cancer. Both intravenous and oral ibandronic acid reduced metastatic bone pain scores below baseline levels for up to 2 years. Oral ibandronic acid is administered as a single 50 mg tablet taken once daily. It suppressed bone resorption in breast cancer patients with bone metastases to an extent similar to that observed with intravenous zoledronic acid. Both intravenous and oral ibandronic acid were well tolerated with no evidence of renal toxicity. Ibandronic acid is therefore a valuable addition to the bisphosphonates used in the treatment of bone metastases of breast cancer, offering high potency and the convenience of oral administration, combined with the absence of renal toxicity.     

Triple-negative breast cancer: epidemiology and management options

The triple receptor-negative breast cancer (TNBC) subtype is characterized by the lack of expression of both hormone receptors as well as lack of over-expression and/or lack of gene amplification of human epidermal growth factor receptor 2 (HER2). Approximately 10-15% of breast carcinomas are known to be of the TNBC subtype, which constitutes approximately 80% of all 'basal-like tumours'. Risk factors for TNBC include young age at breast cancer diagnosis, young age at menarche, high parity, lack of breast feeding, high body mass index and African American ethnicity. The majority of BRCA1 tumours are TNBC. TNBC has a worse prognosis and tends to relapse early compared with other subtypes of breast cancer. Conversely, it displays increased chemosensitivity compared with other breast tumour subtypes. Several agents are currently being investigated as potential therapeutic agents for the treatment of women with TNBC including agents targeted against EGFR, anti-angiogenic agents, multityrosine kinase inhibitors and poly (ADP-ribose) polymerase (PARP) inhibitors. This review focuses on the epidemiology of TNBC, its pathological features, natural history and recurrence patterns as well as current and future management options.     

三阴性乳腺癌临床病理特征和预后分析

目的 分析雌激素受体(ER)、孕激素受体(PR)和人类表皮生长因子受体2 (HER-2)三阴性乳腺癌的临床病理特征和预后.方法 经病理确诊的乳腺癌患者613例分为三阴性乳腺癌组(A组,122例)和非三阴性乳腺癌组(B组,491例).比较两组患者的临床病理特征、复发和远处转移及生存情况.结果 A组髓样癌发生率21.3％,组织学Ⅲ级占60.6％,p53基因阳性表达率73.7％,均明显高于B组的5.9％,30.9％,40.9％ (P＜0.05);A组淋巴结转移率高于B组(49.2％vs.40.1％)P＜0.05);A组局部复发率和肝、肺转移率均显著高于B组(P＜0.05).生存分析显示,A组5年无瘤生存率和5年总生存率分别为65％和81％,均显著低于B组的76％和88％(P＜0.05).结论 三阴性乳腺癌具有特定的临床特征,无瘤生存率和总生存率明显低于非三阴性乳腺癌患者.     

Trastuzumab: a pharmacoeconomic review of its use in early breast cancer

Trastuzumab (Herceptin) is a monoclonal antibody approved for the treatment of breast cancer that overexpresses human epidermal growth factor receptor 2 (HER2). Well designed clinical trials in women with early breast cancer have demonstrated that 1 years' therapy with adjuvant intravenous trastuzumab (a loading dose followed by 6 mg/kg every 3 weeks or 2 mg/kg weekly) significantly improves disease-free survival and overall survival compared with observation (subsequent to chemotherapy) or chemotherapy alone in women with HER2-positive disease. In the HERA trial, disease-free survival was estimated to improve by 6.3% at 3 years in the trastuzumab group compared with the observation group. Trastuzumab is generally well tolerated. The most common adverse events are infusion-related symptoms, such as fever and chills, which usually occur with administration of the first dose. Cardiotoxicity occurs in a small proportion of patients receiving trastuzumab, particularly when coadministered with anthracyclines, and cardiac assessment is recommended for all patients at baseline and at 3-monthly intervals. In modelled cost-effectiveness analyses based on data from clinical trials in patients with HER2-positive early breast cancer, adjuvant trastuzumab was predicted to be cost effective from a healthcare payer or societal perspective in several countries. Incremental costs per QALY or life-year gained with trastuzumab administered subsequent to or concurrent with chemotherapy compared with chemotherapy alone were consistently within accepted local thresholds for cost effectiveness. Sensitivity analyses demonstrated that these results remained generally robust to plausible changes in key model assumptions. In conclusion, in patients with HER2-positive early breast cancer, the addition of adjuvant trastuzumab is clinically effective in improving disease-free survival. Available pharmacoeconomic data from several countries, despite some inherent limitations, support the use of adjuvant trastuzumab for 1 year as a cost-effective treatment relative to chemotherapy alone in this patient population.     

Nab-paclitaxel in the treatment of metastatic breast cancer: a comprehensive review

The novel paclitaxel formulation (nanoparticle albumin-bound [nab] paclitaxel (Abraxane(?)) has recently been approved by the US FDA for treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months after adjuvant chemotherapy. Apart from its superior efficacy, as demonstrated in the pivotal Phase III study, less toxicity compared with the traditional solvent-containing paclitaxel (Taxol(?)) seems to contribute to its favorable therapeutic index. While approved as a single agent, nab-paclitaxel may prove more effective in combination with either biologic agents and/or other cytotoxic chemotherapeutic agents, as summarized in this article.     

Nab-paclitaxel in the treatment of metastatic breast cancer: a comprehensive review

The novel paclitaxel formulation (nanoparticle albumin-bound [nab] paclitaxel (Abraxane^®) has recently been approved by the US FDA for treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months after adjuvant chemotherapy. Apart from its superior efficacy, as demonstrated in the pivotal Phase III study, less toxicity compared with the traditional solvent-containing paclitaxel (Taxol^®) seems to contribute to its favorable therapeutic index. While approved as a single agent, nab-paclitaxel may prove more effective in combination with either biologic agents and/or other cytotoxic chemotherapeutic agents, as summarized in this article.