With advancements in technology and the emergence of innovative drugs, the five-year survival rate for breast cancer in China has reached 83%, significantly higher than that for many other types of cancer. However, it is important not to overlook that some patients still experience recurrence or metastasis, progressing to advanced breast cancer. This remains a significant challenge in further improving the five-year survival rate. So, what are the common characteristics of breast cancer patients who are prone to recurrence and metastasis?
Professor Ma Fei, Director of the Medical Treatment Center at the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences, told Sohu Health that breast cancer recurrence and metastasis are influenced by multiple factors. Firstly, patients with more advanced-stage tumors are more likely to experience recurrence or metastasis, which is related to the timeliness of diagnosis. Currently, the rate of stage I diagnosis for breast cancer in China is around 27% to 28%. If patients are diagnosed at stages II or III, their risk of recurrence naturally increases. Secondly, patients who receive non-standard treatments are more prone to recurrence and metastasis. Breast cancer treatment emphasizes a comprehensive approach, including surgery, chemotherapy, endocrine therapy, targeted therapy, and radiotherapy. There are established guidelines for treatment methods, dosages, and duration. Poor adherence to treatment or non-compliance with standard protocols can increase the risk of recurrence and metastasis.
Certainly, even some patients who detect their condition relatively early or receive standardized treatment may also experience recurrence or metastasis. Professor Ma Fei pointed out that for these patients, it might be necessary to look into the biological behavior of the tumor itself for reasons, meaning that the malignancy level is relatively high.
Given that advanced breast cancer is more challenging to treat, increasing the cure rate of early-stage patients while reducing the rate of recurrence and metastasis is an urgent issue that needs to be addressed at this stage. Clinical doctors are also continuously exploring effective means to this end.
Taking the most common HR+/HER2- subtype as an example, Professor Ma Fei points out that patients with this subtype are sensitive to endocrine therapy. For patients at high risk of recurrence and metastasis, one of the most important strategies is adjuvant intensified therapy, which involves introducing targeted therapies such as CDK4/6 inhibitors to enhance the efficacy of endocrine therapy.
In the salvage treatment of advanced patients, CDK4/6 inhibitors also play a crucial role. "Currently, it appears that combining CDK4/6 inhibitors with first-line treatment for advanced disease significantly improves progression-free survival (PFS). By the time patients reach second-line treatment, they often develop greater resistance to endocrine therapy; however, combining CDK4/6 inhibitors at this stage can also significantly improve treatment outcomes," Professor Ma Fei summarizes. According to existing clinical research data, ribociclib stands out as a CDK4/6 inhibitor that has provided significant benefits in both PFS and overall survival (OS).
Furthermore, for patients with advanced breast cancer, it is also important to pay attention to the state of "visceral crisis." Professor Ma Fei explains that visceral crisis not only refers to visceral metastasis but also indicates damage to vital organs. Currently, all breast cancer treatment guidelines recommend chemotherapy as the first choice for rapidly progressing disease or highly symptomatic conditions and life-threatening visceral crises in advanced breast cancer. However, for these patients, the effectiveness of chemotherapy may not be high, and there are significant safety concerns associated with the treatment.
"Recent clinical studies have found that for patients with visceral metastasis and some cases of visceral crisis, if they exhibit secondary resistance to endocrine therapy or are sensitive to it, using ribociclib (a CDK4/6 inhibitor) combined with endocrine therapy can yield better results than chemotherapy," Professor Ma Fei explained. These study findings suggest that future guidelines for the management of visceral crisis might change, yet more clinical research evidence is still needed to support such changes.
According to reports, ribociclib tablets have been included in the National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalog (2023), achieving medical insurance access within less than 12 months of approval. Professor Ma Fei said that the timely inclusion of innovative drugs into the national medical insurance system aids in enhancing drug accessibility and patient compliance, ultimately translating into extended survival for patients.
