The impact Epothilones have demonstrated in tumors that are resistant to conventional treatment in advanced stages and metastásicasLa Mexican Society of Oncology, AC (SMeO) presented the recommendations of the Expert Panel on Mexican metastatic breast cancer with the aim of presenting an update on the diagnosis and treatment options for patients in Mexico.

The presentation of these recommendations complements the Mexican Consensus Breast Cancer, presented the 2008 SMeO and considers the inclusion of epothilone, a new therapeutic class thus far been absent in our country and whose first product is now available in Mexico through Laboratory Bristol-Myers Squibb.

Media conference, Dr. Cristian Villanueva, Argentine specialist assigned to the University Hospital of Besançon, France, said that “Epothilones have proven effective in tumors resistant to traditional treatments, and a manageable safety profile in cancer patients of locally advanced or metastatic breast cancer who had not previously responded to treatment. “

The Food and Drug Administration USA (FDA for its acronym in English) and approved the use of epothilone for the treatment of patients with breast cancer resistant locally advanced or metastatic, or for patients whose cancer is resistant to regular treatments.

In Mexico, the first epothilone already authorized by the health authorities and is now available. This treatment is the result of nearly 10 years of oncology drug research from Bristol Myers Squibb.

Breast cancer has become a public health problem worldwide and is the most common cancer in women and causes the most deaths. According to WHO, every 30 seconds is diagnosed with breast cancer in the world.

In Mexico every 2 hours a woman dies as a result of breast cancer and this disease now represents the second cause of death among women 30 to 54 years of age. Only in 2006 killed an estimated 4.451 women and that by 2010 there will be a mortality rate of 13 per 100,000 adult women and nearly 4,500 deaths per year.

This increasing trend of disease is related to the aging population and greater prevalence of risk factors for the female population. Unlike other countries where the incidence of such illnesses affect women over 60 years in our country 46% of women affected by breast cancer have less than 50 years.

Metastatic Breast Cancer: a worrisome reality

Over 60% of diagnosed cases are detected late, which means less chance for recovery and survival. Although the median survival of patients has increased in recent years, the Metastatic Breast Cancer (MBC) remains a difficult condition to treat and an ongoing challenge for oncologists, and to prove just enough to review some figures:

• Between 5 and 10% of the women present at diagnosis CMM.

• From 20 to 50% of which were diagnosed at an earlier stage may develop.

• Of women who undergo treatment at an early stage, 40% eventually will develop CMM in a span of 3 years.

• The average survival is only 2 to 3 years.

• The survival rate at 5 years is only 26%.

Dr. Rogelio Martinez Macias, President of the Mexican Society of Oncology from January 2010, said the Expert Panel recommendations are aimed at keeping Mexicans updated treatment regimens in order to safeguard the lives of women today with this type of cancer as well as to have a guide for physicians nationwide to guide them on treatment options in advanced stages and in the metastatic phase.

A study in the Mexican Social Security Institute said Nayarit, Guerrero, Mexico State had a 300% increase in mortality in women over 20 years for this type of cancer. Hence the concern to keep these updated recommendations.

Breast cancer can also be called breast cancer and is the disorderly growth of cells in the mammary glands that is usually detected as a lump in the breast. According to the Histopathological Registry Malignancies in Mexico are found approximately 12 thousand new cases annually and 45.5 percent of these occur before age 50.

The locally advanced breast cancer can occur from stage II, while the metastatic stage IV presents the disease and may present both clinical variables and evolution.

In all cases, the chances of survival improve considerably when you have an early diagnosis, hence the importance of having an appropriate and effective treatment, which has evolved in recent years, hence, the range of options first-line treatments for metastatic breast cancer has increased in complexity, depending on the interaction between tumor, patient and medical variables.

Dr. Juan Alejandro Silva, Chief of Medical Oncology Siglo XXI IMSS, noted that “innovation in treatment has led to a decline in mortality rates of about 20% over the past decade” and currently, treatment decisions should take into account tumor characteristics, toxicity, potential impact on quality of life and patient preference, in addition to the safety and efficacy data.

Treatment of CMM: chemotherapeutic agents

There are different classes of chemotherapeutic agents alone or in combination with other drugs (chemotherapy or other) are used to treat the CMM. Chemotherapeutic agents act in different ways according to their biochemical activity, its origins or its activity on the cell cycle.

Choice of treatment: what is most effective chemotherapeutic agent: Taking into account factors such as age, general health status, symptoms, duration of disease, previous treatment and relapse, therapeutic objectives, the state of HER2 receptor status of estrogen and progesterone, the tumor mass, and some factors, the oncologist selects the treatment considered most appropriate for treating each patient CMM.

When treatment does not work: resistance to chemotherapy.

Although various chemotherapeutic agents available to treat the CMM, the rate of resistance to these agents is a common problem in patients, in fact it is estimated that the resistance is responsible for treatment failure in more than 90% of patients, having two types of resistance:

The mechanisms of resistance are many and varied and are related to the mechanism of action of each class of chemotherapeutic agent.

Resistance to taxanes is mediated by multiple mechanisms:

Anthracyclines and taxanes are two of the most widely used agents in the treatment of CMM.

The mechanisms of resistance to these drugs include: increased drug ejector pumps and alterations in therapeutic drug targets. Currently, the taxanes have become the backbone of cytotoxic treatment in breast cancer. Even its use has been extended to early stages of the disease.

Unfortunately, these agents are highly susceptible mainly to two of these mechanisms of resistance efflux pumps that control the drug concentration within the cell and disruption of the beta tubulin that prevents the taxane accede to and stabilizes microtubules; both prevent the agent achieve its goal of induction of apoptosis.

The goal is to better understand the mechanisms of resistance, the implications for the choice of appropriate treatment and less vulnerable to develop new agents to overcome this problem.

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