Hurkens K P G M, Hupperets P S G J, Creemers G J M, Erdkamp F L G, van de Vijver K K, Tjan-Heijnen V C G
Afd. Interne Geneeskunde, Maastricht Universitair Medisch Centrum, Postbus 5800, 6202 AZ Maastricht.
Ned Tijdschr Geneeskd. 2008 Dec 13;152(50):2701-6.
HER2 positive breast cancers are characterized by their aggressive course of disease. Treatment with trastuzumab has significantly improved survival of patients with these cancers. Trastuzumab has few side effects, although in 10-15% of cases it is necessary to interrupt therapy because of cardiotoxicity, in most cases temporarily. It has become clear that patients receiving trastuzumab more frequently develop brain metastases than patients with a HER2 negative tumor. It is important to realize that patients with brain metastases from a HER2 positive breast tumor have a more favorable prognosis than patients with brain metastases from a HER2 negative tumor. Continuation of treatment with trastuzumab should be considered, next to the surgical intervention and/ or radiotherapy. Recently, lapatinib, a tyrosine kinase inhibitor, was registered by EMEA for patients with a HER2 positive tumor after previous treatment with anthracyclines, taxanes and trastuzumab. In combination with capacitabine, this agent leads to partial responses of cerebral metastases. More HER2 targeting drugs are expected to be introduced.
HER2阳性乳腺癌的特点是疾病进展迅速。曲妥珠单抗治疗显著提高了这些癌症患者的生存率。曲妥珠单抗副作用较少，尽管在10% - 15%的病例中，由于心脏毒性需要中断治疗，大多数情况下是暂时中断。已经明确，接受曲妥珠单抗治疗的患者比HER2阴性肿瘤患者更易发生脑转移。重要的是要认识到，HER2阳性乳腺肿瘤脑转移患者的预后比HER2阴性肿瘤脑转移患者更有利。除了手术干预和/或放疗外，应考虑继续使用曲妥珠单抗治疗。最近，酪氨酸激酶抑制剂拉帕替尼已被欧洲药品管理局（EMEA）批准用于先前接受过蒽环类药物、紫杉烷类药物和曲妥珠单抗治疗的HER2阳性肿瘤患者。与卡培他滨联合使用时，该药物可使脑转移灶部分缓解。预计会有更多的HER2靶向药物问世。
