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Similarly, "disease-free survival" is the length of time after patients have received treatment and have no detectable disease. Time to progression (TTP) does not count patients who die from other causes but is otherwise a close equivalent to PFS (unless there are many such events). [2] The FDA gives separate definitions and prefers PFS. [3]
Staging breast cancer is the initial step to help physicians determine the most appropriate course of treatment. As of 2016, guidelines incorporated biologic factors, such as tumor grade, cellular proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression profiling into the staging system.
The majority of drugs used in cancer chemotherapy are cytostatic, many via cytotoxicity. A fundamental philosophy of medical oncology , including combination chemotherapy, is that different drugs work through different mechanisms, and that the results of using multiple drugs will be synergistic to some extent.
The Scandinavian Breast Cancer Study Group 9401 randomised 525 high risk breast cancer patients between March 1, 1994 to March 4, 1998. [21] Principal investigator Jonas Bergh reported no overall survival benefit to high-dose therapy versus a tailored regimen, after a median follow-up time of 27 months.
To ensure that the drug taker who has poor absorption is dosed appropriately, the bottom value of the deviation range is employed to represent real bioavailability and to calculate the drug dose needed for the drug taker to achieve systemic concentrations similar to the intravenous formulation. [4]
The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. [1] [2] Its value is calculated using three pathological criteria: the size of the tumour; the number of involved lymph nodes; and the grade of the tumour. [1] It is calculated to select patients for adjuvant treatment.
Palliative chemotherapy is used to control (but not cure) the cancer in settings in which the cancer has spread beyond the breast and localized lymph nodes. See metastatic breast cancer. Combined therapies These combine, for example, non-drug treatments with localized chemotherapy to limit toxicity and achieve better results. [3]
Drugs come with a recommended dose in milligrams or micrograms per kilogram of body weight, and that is used in conjunction with the patient's age and body weight to determine a safe dose. In single-dose scenarios, the patient's body weight and the drug's recommended dose per kilogram are used to determine a safe one-time dose.
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