Spirig Christian, Thürlimann Beat, Huober Jens
Senologie Zentrum Ostschweiz, Kantonsspital St. Gallen, Rorschacherstrasse 170, St. Gallen.
Ther Umsch. 2008 Apr;65(4):207-10. doi: 10.1024/0040-5930.65.4.207.
A great step was taken in the treatment of the prognostically unfavourable group of Her2-positive breast cancer in the past years with the introduction of the targeted therapy with trastuzumab, which showed significant increase in median survival in the metastatic and adjuvant setting of Her2-positive breast cancer patients. Lapatinib, an oral HER2-tyrosine kinase inhibitor, showed activity in patients with breast cancer progression after trastuzumab. The role of lapatinib in the adjuvant setting will be examined in the ongoing, multicenter, prospective, four-arm ALTTO-trial, which compares the current standard treatment of one year trastuzumab against lapatinib, the combination of trastuzumab and lapatinib and an arm with sequential trastuzumab followed by lapatinib. Another promising treatment option is the VEGF-antibody bevacizumab, which blocks tumor-mediated angiogenesis leading to oxygen undersupply and finally growth inhibition of the tumor. Concerning treatment decision, two ongoing prospective trials in the USA and Europe are eagerly awaited, which examine the role of gene-array assessment in terms of risk stratification and finally tailoring adequate treatment.
在过去几年中，随着曲妥珠单抗靶向治疗的引入，HER2阳性乳腺癌预后不良组的治疗取得了重大进展，这在HER2阳性乳腺癌患者的转移性和辅助性治疗中显示出中位生存期显著延长。拉帕替尼是一种口服HER2酪氨酸激酶抑制剂，在曲妥珠单抗治疗后病情进展的乳腺癌患者中显示出活性。拉帕替尼在辅助治疗中的作用将在正在进行的多中心、前瞻性、四臂ALTTO试验中进行研究，该试验将一年曲妥珠单抗的当前标准治疗与拉帕替尼、曲妥珠单抗和拉帕替尼联合用药以及先使用曲妥珠单抗后使用拉帕替尼的治疗组进行比较。另一种有前景的治疗选择是VEGF抗体贝伐单抗，它可阻断肿瘤介导的血管生成，导致氧气供应不足，最终抑制肿瘤生长。关于治疗决策，美国和欧洲正在进行的两项前瞻性试验备受期待，这两项试验将研究基因阵列评估在风险分层以及最终制定适当治疗方案方面的作用。
