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The epothilone analog ixabepilone exhibits reduced susceptibility to several important tumor survival mechanisms that limit the efficacy of taxanes and anthracyclines. As a single agent, ixabepilone has shown promise in metastatic breast cancer when anthracyclines, taxanes, or capecitabine have failed; and in early-stage breast cancer that is taxane-naïve or has previously received taxanes in the adjuvant or metastatic setting. Compared with capecitabine alone, ixabepilone used in combination with capecitabine in patients previously treated with and resistant to anthracyclines and taxanes produced a 25% reduction in the risk of disease progression. Triple-negative tumors showed particular susceptibility to this doublet. Ixabepilone has also demonstrated efficacy as first-line therapy in combination with targeted agents such as bevacizumab and trastuzumab. Ongoing investigations should provide insight as to how this agent could be integrated into treatment of early-stage disease. In clinical studies, toxicities with ixabepilone were manageable and reversible through dose reduction or delay, even in patients with extensive or heavily-pretreated disease. Thus, ixabepilone represents a useful addition to the therapeutic options available for advanced breast cancer, and it may extend progression-free survival in patients with limited treatment options.
Treatment of triple-negative breast cancer is challenging. Standard adjuvant tretment is considered to be the cobination of anthracycline and taxanes although the role of anthracyclines administered preoperatively remains controversial. Actually, some studies recommended taxane-only regimens. We reviewed literatures to examine whether tissue biomarkers available in an ordinary laboratory setting (eg, haematoxylin and eosin and immunohistochemistry) may predict response to adjuvant anthracyclines in patients with triple-negative breast cancer. Our review showed that Bcl-2, p53, and tumor-infiltrating lymphocytes (TILs) expression may become independent predictors for triple-negative breast cancer. This finding was based on data from retrospective studies, and, thus, randomized controlled study is needed to confirm the present results.
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