Appearance
Systemic therapy for hormone receptor-positive/human epidermal growth factor receptor 2-negative early stage and metastatic breast cancer.
文献信息
| DOI | 10.3322/caac.21777 |
|---|---|
| PMID | 36939293 |
| 期刊 | CA: a cancer journal for clinicians |
| 影响因子 | 232.4 |
| JCR 分区 | Q1 |
| 发表年份 | 2023 |
| 被引次数 | 70 |
| 关键词 | 乳腺肿瘤，临床试验，激素受体阳性，激素治疗，人类表皮生长因子受体2（HER2）阴性乳腺癌 |
| 文献类型 | Journal Article, Review |
| ISSN | 0007-9235 |
| 页码 | 480-515 |
| 期号 | 73(5) |
| 作者 | Laura A Huppert, Ozge Gumusay, Dame Idossa, Hope S Rugo |
一句话小结
本综述探讨了雌激素受体阳性和HER2阴性乳腺癌的病理特征和内分泌耐药机制，并分析了早期及转移性病例的当前和新兴治疗方法，强调了新疗法在改善临床结果中的重要性。随着新治疗选择的增多，确定最佳治疗顺序以提高疗效并减少毒性变得尤为关键。
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乳腺肿瘤 · 临床试验 · 激素受体阳性 · 激素治疗 · 人类表皮生长因子受体2（HER2）阴性乳腺癌
摘要
雌激素受体（HR）阳性和人类表皮生长因子受体2（HER2）阴性乳腺癌的定义是存在雌激素受体和/或孕激素受体，并且缺乏HER2基因扩增。HR阳性/HER2阴性乳腺癌占所有乳腺癌的65%-70%，且其发病率随着年龄的增长而增加。治疗方法因病期而异，内分泌治疗是早期和晚期疾病的主要治疗手段。与细胞周期依赖性激酶4/6抑制剂的联合使用在早期阶段减少了远处复发，并在转移性阶段改善了总体生存率。化疗的使用基于早期阶段的病期和肿瘤生物学特征，以及在晚期疾病中内分泌耐药后的治疗。新疗法，包括新型内分泌药物和抗体药物偶联物，正在改变治疗格局。随着新治疗选择的出现，定义最佳治疗顺序以最大化临床利益并最小化毒性变得尤为重要。在本综述中，作者首先讨论HR阳性/HER2阴性乳腺癌的病理学和分子特征以及内分泌耐药机制。然后，他们讨论了针对早期和转移性HR阳性/HER2阴性乳腺癌的当前和新兴治疗方法，包括基于当前数据的治疗算法。
英文摘要
Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer is defined by the presence of the estrogen receptor and/or the progesterone receptor and the absence of HER2 gene amplification. HR-positive/HER2-negative breast cancer accounts for 65%-70% of all breast cancers, and incidence increases with increasing age. Treatment varies by stage, and endocrine therapy is the mainstay of treatment in both early stage and late-stage disease. Combinations with cyclin-dependent kinase 4/6 inhibitors have reduced distant recurrence in the early stage setting and improved overall survival in the metastatic setting. Chemotherapy is used based on stage and tumor biology in the early stage setting and after endocrine resistance for advanced disease. New therapies, including novel endocrine agents and antibody-drug conjugates, are now changing the treatment landscape. With the availability of new treatment options, it is important to define the optimal sequence of treatment to maximize clinical benefit while minimizing toxicity. In this review, the authors first discuss the pathologic and molecular features of HR-positive/HER2-negative breast cancer and mechanisms of endocrine resistance. Then, they discuss current and emerging therapies for both early stage and metastatic HR-positive/HER2-negative breast cancer, including treatment algorithms based on current data.
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主要研究问题
- 在HR阳性/HER2阴性乳腺癌的不同阶段中，内分泌治疗与化疗的具体适应症和疗效有哪些差异？
- 新型内分泌药物和抗体药物偶联物在HR阳性/HER2阴性乳腺癌治疗中的作用和前景如何？
- 在HR阳性/HER2阴性乳腺癌患者中，内分泌抵抗的机制有哪些，如何影响治疗选择？
- 针对HR阳性/HER2阴性乳腺癌的治疗方案中，如何有效地整合CDK4/6抑制剂以提高临床效果？
- 随着新治疗选项的出现，HR阳性/HER2阴性乳腺癌的治疗顺序应如何调整以优化患者的预后？
核心洞察
1. 研究背景和目的
本文旨在探讨激素受体阳性/人类表皮生长因子受体2阴性（HR-positive/HER2-negative）乳腺癌的系统治疗方法。该类型乳腺癌占所有乳腺癌的65%至70%，且随着年龄增长，其发病率呈上升趋势。研究的目标在于总结当前的治疗策略，特别是内分泌治疗的应用及其与其他疗法的联合使用，以指导临床实践并优化患者的治疗效果。
2. 主要方法和发现
文章回顾了HR-positive/HER2-negative乳腺癌的病理和分子特征，并分析了内分泌耐药机制。对于早期和转移性HR-positive/HER2-negative乳腺癌，内分泌治疗被视为主要治疗手段。在早期阶段，联合使用细胞周期依赖性激酶4/6抑制剂显著降低了远处复发率；而在转移性病症中，则改善了总体生存率。研究还指出，化疗的使用取决于肿瘤的分期及生物学特性，且在晚期疾病的内分泌耐药后也可采用。新疗法的出现，如新型内分泌药物和抗体药物偶联物，正在改变治疗格局。
3. 核心结论
研究表明，内分泌治疗仍然是HR-positive/HER2-negative乳腺癌的基础治疗，而新兴疗法的引入极大丰富了治疗选择。合理的治疗顺序和组合能够最大化临床益处，同时减少治疗毒性。针对不同分期的患者，制定个性化的治疗算法变得尤为重要，以应对不同患者的需求和耐药机制。
4. 研究意义和影响
本研究为HR-positive/HER2-negative乳腺癌的治疗提供了全面的回顾与分析，强调了内分泌治疗与新兴治疗的结合对改善患者预后的重要性。这一研究不仅推动了对乳腺癌的理解，也为临床医生提供了制定治疗策略的依据，促进了个性化医疗的发展。此外，随着新疗法的不断涌现，研究者和临床医生需持续关注治疗方案的优化，以应对不断变化的临床挑战。
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