Abstract
The management of breast cancer with advanced disease or metastasis is a common problem in India and other countries. A panel of 13 oncology experts deliberated on the sidelines of the 35th Indian Cooperative Oncology Network Conference held in Mumbai to formulate an expert opinion recommendation on the novel drug delivery system (NDDS) formulations in the treatment of metastatic breast cancer (MBC). The survey comprised of 39 questions related to limitations of conventional formulations and therapeutic positioning of NDDS formulations of docetaxel, paclitaxel and doxorubicin in the management of MBC. The experts used data from published literature and their practical experience to provide expert opinion and recommendations for use by the community oncologists. The experts opined that the newer NDDS formulations should provide a significant efficacy advantage in terms of overall survival and progression-free survival, or demonstrate better tolerability when compared with conventional formulations. The newer NDDS formulations of taxanes should be considered in special circumstances such as diabetes, in patients who have had hypersensitivity reactions and in cases where steroids need to be avoided. The novel formulations of doxorubicin should be used in the elderly and in patients with borderline cardiac function.
Highlights
Breast cancer is the second most common cancer globally, and the most common cancer in women, with an estimated diagnosis of 1.67 million new cases and 522,000 deaths in 2012 [1]
The efficacy of Pegylated‐liposome encapsulated doxorubicin (PLD) has been established for human epidermal growth factor receptor 2 (HER2) positive subgroups; limited data is available on the other subgroups of metastatic breast cancer (MBC) for conventional doxorubicin, liposomal doxorubicin or PLD
In order to increase the therapeutic index, doxorubicin is formulated with pegylated liposomal‐encapsulation technique, which increases the efficacy and reduces the toxicity of doxorubicin by altering tissue distribution
Summary
Breast cancer is the second most common cancer globally, and the most common cancer in women, with an estimated diagnosis of 1.67 million new cases and 522,000 deaths in 2012 [1] It has an age adjusted incidence of 144,937 cases (27%), a mortality rate of 21.5% and a 5‐year prevalence rate of 35.3%, which is the highest amongst all cancer types among women in India [1]. Taxanes (docetaxel, paclitaxel) and anthracyclines (doxorubicin) are the most active and common chemotherapeutic agents used in the management of MBC with an objective response yield of 20‐80% as single agents [6,7,8]. The objectives of the meeting were to examine the limitations of conventional formulations and advantages of novel drug formulations, and provide expert opinion on the use of novel drug formulations of docetaxel, paclitaxel, and doxorubicin in the management of MBC based on published evidence and own experience
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