Engel Ryan H, Kaklamani Virginia G
Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine and the Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA.
Drugs. 2007;67(9):1329-41. doi: 10.2165/00003495-200767090-00006.
In the year 2006, breast cancer was estimated to affect >200,000 American women and cause nearly 56,000 deaths. Furthermore, breast cancer is the most common cancer diagnosed and second most common cause of cancer-related deaths in women. The current treatment armamentarium for breast cancer includes chemotherapy, endocrine therapy and biological therapy. Treatment has become more individualised based on characteristics of the tumour including overexpression of the human epidermal growth factor receptor (HER)-2. Between 20 and 30% of all breast cancers overexpress HER2, which means 40,000 - 60,000 patients will have this type of cancer.Previously, overexpression of HER2 was a negative prognostic and predictive risk factor for survival; however, with the advent of trastuzumab, patients' prognosis is improving in all treatment settings. Much controversy exists in the use of trastuzumab, including (i) the sequence of adjuvant trastuzumab (concurrent with chemotherapy or sequential); (ii) the treatment duration (<1 year, 1 year or 2 years); and (iii) the treatment choice upon disease progression (whether to continue or not with trastuzumab and add another cytotoxic agent). Current trials are ongoing to help answer these questions.Furthermore, there has been interest in predicting which HER2-positive patients would require anthracycline therapy, and which could avoid anthracycline therapy and its toxicities. Novel therapeutics, such as lapatinib, an oral tyrosine kinase inhibitor, which blocks both the epidermal growth factor receptor and HER2 receptor has recently been approved by the US FDA. Whereas pertuzumab, a humanised monoclonal antibody, directed against heterodimerisation of HER2 and HER3 has entered phase II and III clinical trials.
2006年，据估计乳腺癌影响了超过20万美国女性，并导致近56000人死亡。此外，乳腺癌是女性中诊断出的最常见癌症，也是癌症相关死亡的第二大常见原因。目前乳腺癌的治疗手段包括化疗、内分泌治疗和生物治疗。基于肿瘤特征，包括人表皮生长因子受体（HER）-2的过表达，治疗已变得更加个体化。所有乳腺癌中20%至30%过表达HER2，这意味着4万至6万患者患有这种类型的癌症。以前，HER2过表达是生存的不良预后和预测风险因素；然而，随着曲妥珠单抗的出现，在所有治疗环境中患者的预后都在改善。曲妥珠单抗的使用存在很多争议，包括（i）辅助曲妥珠单抗的顺序（与化疗同时使用或序贯使用）；（ii）治疗持续时间（<1年、1年或2年）；以及（iii）疾病进展时的治疗选择（是否继续使用曲妥珠单抗并添加另一种细胞毒性药物）。目前正在进行试验以帮助回答这些问题。此外，人们一直关注预测哪些HER2阳性患者需要蒽环类药物治疗，哪些可以避免蒽环类药物治疗及其毒性。新型治疗药物，如拉帕替尼，一种口服酪氨酸激酶抑制剂，可同时阻断表皮生长因子受体和HER2受体，最近已获得美国食品药品监督管理局批准。而帕妥珠单抗，一种针对HER2和HER3异二聚化的人源化单克隆抗体，已进入II期和III期临床试验。
