Chemotherapy and Other Drugs Used in Metastatic Cancer
Patients who develop metastatic disease (cancer that spreads throughout the body) are generally not curable. Combination therapies, however, are often effective at shrinking tumors and improving quality of life. In some cases, such therapies may improve survival. These drug regimens usually combine a taxane drug, such as docetaxel (Taxotere) or paclitaxel (Taxol), with an anthracycline drug, such as doxorubicin (Adriamycin) or epirubicin (Ellence).
Other promising combinations and single drugs include:
- Cyclophosphamide, 5-fluorouracil (5-FU), and methotrexate (CMF) with a corticosteroid (such as prednisone).
- Capecitabine (Xeloda). This is an oral drug that is sometimes used as a substitute for 5-FU or CMF, especially in older patients. Studies have reported response rates of up to 26% in patients previously treated with chemotherapy and of 30% when used as the first treatment for metastatic breast cancer. Capecitabine is also showing good results in combination with lapatinib (Tykerb) in treating women with advanced HER2 positive cancer that did not improve with trastuzumab therapy. As a result, in March 2007, the Food and Drug Administration approved this combination treatment for patients whose cancer failed to respond to trastuzumab.
- Trastuzumab (Herceptin). Trastuzumab destroys cells carrying the HER2 protein, and is being used in women who test positive for the gene that regulates this protein. HER2 plays a role in cancer cell growth in about 30% of patients. This drug helps improve survival rates in patients with HER2 positive metastatic breast cancer when it is used in combination with paclitaxel.
Other drugs showing promise in chemotherapeutic regimens for metastatic cancer include bevacizumab (Avastin), vinorelbine (Navelbine), pemetrexed (Alimta), gemcitabine (Gemzar), edatrexate, losoxantrone, and platinum-based drugs (cisplatin, carboplatin, oxaplatin).
Bisphosphonates. Bisphosphonates (Zometa, Aredia) are important supportive drugs for preventing fractures and reducing pain in people whose cancer has spread to the bones. Clodronate and pamidronate are the drugs currently used, and newer bisphosphonates (ibandronate and zoledronate) are being studied. To date, evidence strongly supports their use for reducing pain and improving quality of life. Bisphosphonates are also being investigated in early-stage breast cancer, with some studies suggesting that they may help prevent metastasis in the bone and improve survival rates.
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