Dienstmann Rodrigo, Bines Jose
Medical Oncology, Instituto Nacional de Cancer, Rua Visconde de Santa Isabel, 374/3 Andar, Vila Isabel, CEP 20560-120 Rio de Janeiro, Brazil.
Clin Breast Cancer. 2006 Oct;7(4):315-20. doi: 10.3816/CBC.2006.n.043.
Breast cancer is the most common malignancy among women in Western countries. The management of patients with nonmetastatic breast cancer with primary endocrine therapy has evolved dramatically in the past decade. Neoadjuvant treatment has been used to turn inoperable tumors into operable tumors and also to downstage tumors. Hormone receptor-positive breast tumors exposed to neoadjuvant chemotherapy have lower rates of pathologic complete response than hormone receptor-negative tumors. Recently, clinical trials showed an increased response rate and a higher rate of breast-conserving surgery with aromatase inhibitors compared with tamoxifen. Exploratory data suggest that predictive markers of response include a higher estrogen receptor expression level and a negative HER2 status. With the introduction of "biologic" agents and surrogate markers like Ki-67, several studies are evaluating which patients are more likely to respond to preoperative hormonal agents. This review summarizes recent data on neoadjuvant endocrine therapy for breast cancer and the implication of predictive markers of response into clinical practice and future research.
乳腺癌是西方国家女性中最常见的恶性肿瘤。在过去十年中，原发性内分泌治疗的非转移性乳腺癌患者的管理发生了巨大变化。新辅助治疗已被用于将无法手术的肿瘤转变为可手术的肿瘤，同时也用于降低肿瘤分期。与激素受体阴性肿瘤相比，接受新辅助化疗的激素受体阳性乳腺肿瘤的病理完全缓解率较低。最近，临床试验表明，与他莫昔芬相比，芳香化酶抑制剂的反应率增加，保乳手术率更高。探索性数据表明，反应的预测标志物包括较高的雌激素受体表达水平和HER2阴性状态。随着“生物”制剂和Ki-67等替代标志物的引入，多项研究正在评估哪些患者更有可能对术前激素制剂产生反应。本综述总结了乳腺癌新辅助内分泌治疗的最新数据以及反应预测标志物在临床实践和未来研究中的意义。
