Chavez-MacGregor Mariana, Gonzalez-Angulo Ana Maria
Division of Cancer Medicine, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
Clin Adv Hematol Oncol. 2009 Sep;7(9):591-8.
Human epidermal growth factor receptor 2 (HER2-neu) is an important prognostic factor associated with worsened disease-free survival and overall survival in breast cancer patients; however, the prognosis of T1a,b,N0,M0 HER2-neu positive breast cancer has not been clearly determined. Trastuzumab has become a critical component of the treatment of patients with HER2-neu positive tumors, but the effect of treatment in patients with small tumors and node-negative disease has not been evaluated in clinical trials. Current guidelines have category 3 recommendations to consider the use of adjuvant trastuzumab in women with node-negative tumors that are 0.6-1.0 cm, and state that physicians should balance the risks associated with the known trastuzumab toxicities and the uncertain benefits that may exist with such therapy in this group of patients. The available data regarding the prognosis of patients with T1a,b,N0,M0 HER2-neu positive breast cancer is very limited. The purpose of this manuscript is to review the available literature in order to evaluate whether this group of patients represents a high risk group. Retrospective studies suggest that HER2-neu status is a powerful independent prognostic factor in T1a,b node-negative breast cancer. We believe that prospective studies and randomized clinical trials are strongly needed to clearly assess the impact of HER2-neu positivity in node-negative and subcentimeter tumors, and to determine if this group of patients can benefit from adjuvant trastuzumab treatment.
人表皮生长因子受体2（HER2-neu）是与乳腺癌患者无病生存期和总生存期恶化相关的重要预后因素；然而，T1a、b、N0、M0 HER2-neu阳性乳腺癌的预后尚未明确确定。曲妥珠单抗已成为HER2-neu阳性肿瘤患者治疗的关键组成部分，但在临床试验中尚未评估其对小肿瘤和无淋巴结转移疾病患者的治疗效果。当前指南有3类推荐意见，即考虑对肿瘤大小为0.6 - 1.0 cm的无淋巴结转移肿瘤女性使用辅助性曲妥珠单抗，并指出医生应权衡已知的曲妥珠单抗毒性相关风险以及该治疗方法对这组患者可能存在的不确定益处。关于T1a、b、N0、M0 HER2-neu阳性乳腺癌患者预后的现有数据非常有限。本手稿的目的是回顾现有文献，以评估这组患者是否属于高危组。回顾性研究表明，HER2-neu状态是T1a、b期无淋巴结转移乳腺癌的有力独立预后因素。我们认为，迫切需要进行前瞻性研究和随机临床试验，以明确评估HER2-neu阳性对无淋巴结转移和肿瘤直径小于1厘米的肿瘤的影响，并确定这组患者是否能从辅助性曲妥珠单抗治疗中获益。
