BC Cancer Agency, Vancouver Cancer Centre, Vancouver, BC V5Z 4E6, Canada.
Future Oncol. 2011 Jan;7(1):37-55. doi: 10.2217/fon.10.163.
Anthracycline-based regimens became the standard of care for early breast cancer patients based on the survival advantage they provide over nonanthracycline-containing regimens. The addition of taxanes, and subsequently trastuzumab in HER2-overexpressing patients, to anthracyclines further improved their efficacy in several studies involving high-risk early breast cancer patients. Concern over toxicity initially surfaced after anthracyclines were reported to carry an increased risk of cardiotoxicity and secondary leukemia. Trastuzumab has since been shown to compound the risk of cardiotoxicity in patients who have received an anthracycline. This has led to the development of regimens featuring a taxane without an anthracycline; these protocols vary in design and have different toxicity and efficacy profiles. Ongoing investigations are centered on the optimization of nonanthracycline regimens, prospective exploration of molecular markers to identify populations of patients who will derive maximal benefit from anthracycline-based chemotherapy, and the identification of less cardiotoxic formulations of existing anthracycline agents. Perhaps most importantly, a rapidly growing understanding of the biological heterogeneity of breast cancer is likely to lead to an individualized standard of care guided by particular patient and tumor characteristics.
基于蒽环类药物方案在生存方面优于不含蒽环类药物的方案，蒽环类药物方案成为早期乳腺癌患者的标准治疗方案。在几项涉及高危早期乳腺癌患者的研究中，紫杉烷类药物的加入，以及随后在 HER2 过表达患者中加入曲妥珠单抗，进一步提高了其疗效。在蒽环类药物被报道具有更高的心脏毒性和继发性白血病风险后，人们最初对其毒性表示担忧。曲妥珠单抗已被证明会增加接受蒽环类药物治疗的患者的心脏毒性风险。这导致了不含蒽环类药物的紫杉烷类药物方案的发展；这些方案在设计上有所不同，具有不同的毒性和疗效特征。正在进行的研究集中在优化非蒽环类药物方案、前瞻性探索分子标志物以确定从蒽环类药物化疗中获益最大的患者人群，以及寻找现有蒽环类药物更具心脏毒性的制剂。也许最重要的是，对乳腺癌生物学异质性的理解正在迅速加深，这可能会导致根据特定患者和肿瘤特征制定个体化的标准治疗方案。
