Review
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World J Clin Oncol. Feb 10, 2011; 2(2): 125-134
Published online Feb 10, 2011. doi: 10.5306/wjco.v2.i2.125
Current status of therapy for breast cancer worldwide and in Japan
Youngjin Park, Tomoaki Kitahara, Ryuichi Takagi, Ryoji Kato
Youngjin Park, Tomoaki Kitahara, Ryuichi Takagi, Ryoji Kato, Department of Surgery, Sakura Medical Center, School of Medicine, Faculty of Medicine, Toho University, Sakura, Chiba Prefecture 285-8741, Japan
Author contributions: Park Y designed the concept and this study; Kitahara T and Takagi R acquired the data; Park Y, Kitahara T, Takagi R and Kato R analysed and interpreted the data; Park Y drafted the manuscript; Park Y, Kitahara T, Takagi R and Kato R were critical revision of the manuscript for important intellectual content; Kato R supervised the study.
Correspondence to: Youngjin Park, MD, PhD, Associate Professor, Department of Surgery, Sakura Medical Center, School of Medicine, Faculty of Medicine, Toho University, Sakura, Chiba Prefecture 285-8741, Japan. youngjinpark@sakura.med.toho-u.ac.jp
Telephone: +81-43-4628811 Fax: +81-43-4628820
Received: August 19, 2010
Revised: September 26, 2010
Accepted: October 2, 2010
Published online: February 10, 2011
Abstract

The results of clinical trials conducted in Europe and North America have been incorporated into treatment strategies for breast cancer in Japan. Despite the use of similar treatment regimens, why has mortality from breast cancer been increasing in Japan? Procedures for surgical treatment and sentinel lymph node biopsy in breast cancer do not differ between Japan and Western countries, but the strategies for radiotherapy differ slightly. Hormonal therapy is now selected on the basis of scientific evidence, and similar regimens are used in Japan and Western countries. As for postoperative adjuvant chemotherapy, an anthracycline plus cyclophosphamide and taxane-based regimens are standard treatments in Japan and Western countries. In 2009, however, the results of two large clinical studies designed to determine whether intravenous or oral treatment was superior for postoperative adjuvant chemotherapy were reported in Japan. Both studies showed that relapse-free survival and overall survival (OS) at 5 years after surgery were similar for a combination of cyclophosphamide, methotrexate, and 5-fluorouracil and for tegafur/uracil. Many chemotherapeutic agents that are used to treat recurrent or metastatic breast cancer have not yet been approved in Japan. As for molecular targeted therapy, some agents that target the human epidermal growth factor receptor family have been approved in Japan, whereas angiogenesis inhibitors have not. The results of many clinical trials have been incorporated into clinical practice in Japan, therefore, the outcomes of breast cancer therapy have surpassed those in other countries. Many pivotal clinical trials have been conducted outside Japan. Treatment regimens that have been developed on the basis of these studies might be suitable for the management of breast cancer in Western women, but not for Japanese women because of differences in genetic factors, physique, body mass index, pharmacokinetics, and drug metabolism. Such regimens should be modified on the basis of the characteristics of breast cancer in Japan to develop treatment that is optimally suited for Japanese women. In particular, local studies of pharmacokinetics, pharmacodynamics, and optimal dose levels and treatment intervals should be carefully performed. The establishment of treatment regimens optimally suited for Japanese patients with breast cancer could put the brakes on the trend towards increasing mortality from breast cancer in Japan.

Keywords: Breast cancer; Breast-conservation therapy; Hormonal therapy; Chemotherapy; Molecular targeted therapy