3HER2 is an important prognostic factor for breast cancer. HER2-positive (overexpressed or expanded) breast cancer has special clinical features and biological behavior, and the treatment pattern is also very different from other types of breast cancer. 1. HR+/HER2-prognosis of breast cancer is superior to other subtypes HR+ breast cancer lesions grow slowly and are effective against a variety of treatments (such as endocrine therapy). A clinical trial of 934 breast cancer subjects showed that the risk of death in patients with HR-/HER2+ or HR+/HER2+ breast cancer is HR+/HER- twice as many as breast cancer patients. 2. Most patients with HR+/HER2- breast cancer are in advanced stage or have metastasis The Datamonitor survey showed that most of the HR+/HER2- patients who had metastases were in stage IV or had a distant recurrence. In the United States, Japan, and Europe, the percentage of patients with stage IV or distant recurrence was 18% and 14%, respectively. In addition, the proportion of patients with local recurrence, stage I, stage II, and stage III was 7%, 17%, 19%, and 25%, respectively. Unlike the United States and five European countries, most of the Japanese patients are diagnosed at stage I, which may be related to the younger age of diagnosis. According to reports, the highest age of breast cancer in Japan in 2014 was 45–49 years old, which is smaller than in the United States and European countries, which may be related to the refined lifestyle. 3, adjuvant therapy is the most commonly used treatment for patients with surgery and chemotherapy, endocrine therapy is still the standard treatment for adjuvant therapy Adjuvant therapy is the recommended treatment for I-III HR+/HER2- breast cancer guidelines. The application is more widely used. In contrast, neoadjuvant therapy is less used. According to the 2016 NCCN guidelines, endocrine therapy is the recommended treatment for HR+ breast cancer patients, regardless of menopause, regardless of HER2 status. The most commonly used endocrine therapy in the United States, Japan, and Europe is anastrozole, followed by tamoxifen and letrozole. Adjuvant chemotherapy is also one of the effective treatments, commonly used before the endocrine therapy. Doxorubicin is associated with cyclic adenosine monophosphate, and sequential paclitaxel is the most commonly used adjuvant chemotherapy regimen. 4, stage IV patients with systemic treatment Patients with advanced stage are often accompanied by metastatic lesions other than the primary tumor. The prognosis is poor. Drug intervention is often used. Surgery is rare. Even surgery is aimed at reducing the tumor burden of the primary tumor rather than trying to cure the disease. The Datamonitor survey found that the longest-term regimen for advanced HR+/HER2- breast cancer was systemic therapy alone (about 56% of patients with advanced disease), followed by surgery combined with systemic therapy (about 12% of patients with advanced disease). Systemic therapy is also a first-line treatment for advanced patients. 5, Palbociclib approved for the addition of a choice for systemic treatment of advanced patients Systemic treatment in the first-line treatment regimen included endocrine therapy and chemotherapy, and after the approval of Pfizer Pharmaceuticals Palbociclib, the patient's protocol had an additional option. According to Datamonitor data, since the approval in 2015, Palbociclib combined with letrozole has become the second common treatment in the first-line therapy of patients with advanced HR+/HER2- breast cancer who have not undergone surgery in the United States (applicable population accounts for 17% of advanced patients) . 6, the second phase of the patients commonly used second-line program for the combination of everolimus with exemestane, the three-four line program varies from place to place The combination of everolimus and exemestane is the most common second-line regimen in the late stage (about 13% of patients choose this option). The highest usage rate in the United States is 21%, followed by Italy (19%). The choice of the third and fourth line options depends on what kind of treatment the patient has received before and the state of menopause. For postmenopausal patients, if endocrine therapy is not received within one year, a non-steroidal aromatase inhibitor such as letrozole or anastrozole, or an estrogen receptor modulator such as tamoxifen or fulvestrant may be selected. Palbociclib in combination with letrozole can also be used in such patients. Premenopausal patients can receive endocrine therapy after simulating postmenopausal patients after receiving ovarian ablation or inhibition. Bevacizumab in combination with paclitaxel can be used for patients with distant metastases.
10% Apple Cider Vinegar Powder ,Apple cider vinegar powder in apple extract is a kind of Apple Extract, is our company's Fruit&Vegetable Power with apple fruit as raw material, after extraction, concentration, drying and become white or light yellow powder.
Apple Cider Vinegar Powder,Apple Cider Vinegar Powder Bulk,Apple Cider Vinegar Powder Herb,10% Apple Cider Vinegar Powder Shaanxi Kepler Biotech Co.,Ltd , https://www.keplerherb.com
Apple are native to central and southeastern europe, central and western asia, and xinjiang in china.later, the romans began cultivation and grafting.in the 18th century, j.b. Montessori and t.a. Used natural hybridization to select and breed seedlings and gradually promoted cultivation.
Apple cider vinegar is produced by secondary fermentation, which usually refers to liquid fermentation. The apple cider vinegar of liquid fermentation is made of concentrated apple juice or fresh apple juice, which is first fermented into high-purity apple cider, and then acetic acid bacteria are added to carry out acetic fermentation to metabolize alcohol into acetic acid.It is different from solid state fermentation, solid state fermentation is the apple initial processing of the waste, such as peel, core, small fruit, fruit drop, etc., first broken, and then stirred into the bran, fermentation alcohol and fermentation acetic acid at the same time.Features and effects: Apple cider vinegar has good nutritional value, it not only has skin care effect, but also can cure the wine, protect the liver and prevent drunkness. One glass before the wine can inhibit the absorption of alcohol, and one glass after the wine can cure the wine and prevent drunkness.