Gianni Luca, Norton Larry, Wolmark Norman, Suter Thomas M, Bonadonna Gianni, Hortobagyi Gabriel N
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy.
J Clin Oncol. 2009 Oct 1;27(28):4798-808. doi: 10.1200/JCO.2008.21.4791. Epub 2009 Aug 17.
To review data relating to anthracyclines in the adjuvant treatment of early breast cancer.
This is a report from a seminar in which the future of anthracyclines in the adjuvant treatment of breast cancer was considered. In particular, the question of whether anthracyclines should now be discarded and replaced by taxanes was addressed.
Accumulating data from large randomized trials indicate that genetic markers may have a role in predicting sensitivity to cytotoxic drugs. However, no reliable, validated test is available for predicting sensitivity to anthracyclines in particular. Topoisomerase IIalpha amplification and/or deletion, especially in conjunction with human epidermal growth factor receptor-2 amplification, has been proposed to fulfill this role but more data are needed. Currently, only one published trial has shown that a taxane-based regimen may be superior to an anthracycline-based regimen, but several trials indicate that combinations including both anthracyclines and taxanes may be better still. Further studies aimed at optimizing anthracyclines and taxanes in combination, and integrating biologic agents, seem to be the way forward. There is no validated test that can determine whether anthracyclines can be of greater benefit than other agents for individual patients.
Anthracyclines have been extensively tested in clinical trials spanning several decades; currently, there are insufficient data to recommend replacing them in the adjuvant treatment of breast cancer.
回顾与蒽环类药物在早期乳腺癌辅助治疗中相关的数据。
这是一份关于研讨会的报告，该研讨会探讨了蒽环类药物在乳腺癌辅助治疗中的未来。特别讨论了蒽环类药物现在是否应被舍弃并由紫杉烷类药物替代的问题。
来自大型随机试验的累积数据表明，基因标志物可能在预测对细胞毒性药物的敏感性方面发挥作用。然而，目前尚无可靠的、经过验证的检测方法可用于预测对蒽环类药物的敏感性。有人提出拓扑异构酶IIα扩增和/或缺失，特别是与人类表皮生长因子受体-2扩增同时出现时，可发挥这一作用，但还需要更多数据。目前，仅有一项已发表的试验表明基于紫杉烷类的方案可能优于基于蒽环类的方案，但多项试验表明蒽环类药物和紫杉烷类药物联合使用的方案可能效果更佳。进一步开展旨在优化蒽环类药物与紫杉烷类药物联合使用以及整合生物制剂的研究似乎是前进的方向。没有经过验证的检测方法能够确定蒽环类药物对个体患者是否比其他药物更有益。
蒽环类药物已在跨越数十年的临床试验中得到广泛测试；目前，尚无足够数据支持在乳腺癌辅助治疗中用其他药物替代它们。
