Specht Jennifer, Gralow Julie R
Department of Medicine, Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA.
Semin Radiat Oncol. 2009 Oct;19(4):222-8. doi: 10.1016/j.semradonc.2009.05.001.
Preoperative systemic therapy is the standard of care in locally advanced breast cancer. In this setting, the intent of preoperative systemic therapy is to expand surgical options and to improve survival. Locally advanced and inflammatory breast cancer have different biological features, but they share the use of preoperative (primary, neoadjuvant) systemic therapy as the initial treatment of choice. The management of these patients necessitates involvement of a multidisciplinary team from the onset and during therapy. The eradication of invasive cancer from the breast and axillary lymph nodes, pathologic complete response, is a predictor of outcome associated with improved disease-free and overall survival. However, conventional chemotherapy regimens result in pathologic complete response in only a minority of patients. The management of patients with residual invasive disease after preoperative therapy is a common clinical problem for which additional research is necessary. The differential expression of genes and pathways in locally advanced and inflammatory breast cancer allows for the exploitation of targeted therapy, and early trials have shown exciting target and tumor effects. Much work remains, and future trials combining targeted and conventional therapies based on molecular subtypes and/or specific targets are needed if we hope to improve survival for patients with locally advanced breast cancer.
术前全身治疗是局部晚期乳腺癌的标准治疗方法。在这种情况下，术前全身治疗的目的是扩大手术选择并提高生存率。局部晚期乳腺癌和炎性乳腺癌具有不同的生物学特征，但它们都将术前（初始、新辅助）全身治疗作为首选的初始治疗方法。对这些患者的管理需要从治疗开始及治疗期间多学科团队的参与。从乳腺和腋窝淋巴结根除浸润性癌，即病理完全缓解，是与无病生存期和总生存期改善相关的预后预测指标。然而，传统化疗方案仅使少数患者获得病理完全缓解。术前治疗后残留浸润性疾病患者的管理是一个常见的临床问题，对此需要进行更多研究。局部晚期乳腺癌和炎性乳腺癌中基因和信号通路的差异表达使得靶向治疗得以应用，早期试验已显示出令人振奋的靶点和肿瘤效应。仍有许多工作要做，如果我们希望提高局部晚期乳腺癌患者的生存率，未来需要开展基于分子亚型和/或特定靶点的靶向治疗与传统治疗联合的试验。
