Breast Center of Excellence, NK Basile Cancer Institute, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
Crit Rev Oncol Hematol. 2011 Dec;80(3):433-49. doi: 10.1016/j.critrevonc.2011.01.010. Epub 2011 Feb 16.
Current treatment of metastatic breast cancer (MBC) aims at achieving meaningful clinical responses, improved quality of life, long-term remissions, prolonged survival, and dares to hope for a cure in a small percentage of cases. This article will discuss both consensus and controversies in the management of MBC in the context of the new evolving breast cancer molecular classification. Hormonal therapy remains the mainstay of management of MBC Luminal A and B. Data is emerging on management of ErbB2-positive HR-positive MBC by combining hormonal manipulation and targeted anti-ErbB2 therapy and has recently received regulatory approval in Europe and USA. The optimal use and duration of single agent or combination chemotherapy is discussed. Data and controversies surrounding the use of newer agents such as nab-paclitaxel, ixabepilone, eribulin, and PARP inhibitors as well as trastuzumab is reviewed. Better understanding of pathophysiology has paved the way for the introduction of newer anti-ErbB2 agents such as lapatinib, pertuzumab, T-DM1 and neratinib. Controversies regarding bevacizumab and anti-angiogenesis are discussed. Bisphosphonates have significantly reduced skeletal related events and made significant improvements in the quality of life of patients with MBC. Newer anti-RANK Ligand antibodies show promising results. Significant advances in the understanding of molecular biology of breast cancer have been made and should lead to an improvement in the outcome of MBC. More possibilities of cure can become an attainable goal in the near future.
目前转移性乳腺癌（MBC）的治疗旨在实现有意义的临床反应、提高生活质量、长期缓解、延长生存时间，并在少数情况下敢于希望治愈。本文将根据新的乳腺癌分子分类，讨论 MBC 管理中的共识和争议。激素治疗仍然是管理 MBC 腔 A 和 B 的主要方法。关于通过联合激素治疗和靶向抗-ErbB2 治疗来管理 ErbB2 阳性 HR 阳性 MBC 的数据正在出现，并已在欧洲和美国获得监管批准。本文讨论了单药或联合化疗的最佳使用和持续时间。关于新型药物如 nab-紫杉醇、伊沙匹隆、艾立布林和 PARP 抑制剂以及曲妥珠单抗的使用的数据和争议进行了综述。对发病机制的更好理解为引入新型抗-ErbB2 药物如拉帕替尼、帕妥珠单抗、T-DM1 和奈拉替尼铺平了道路。关于贝伐单抗和抗血管生成的争议进行了讨论。双膦酸盐显著减少了与骨骼相关的事件，并显著提高了 MBC 患者的生活质量。新型抗 RANK 配体抗体显示出有希望的结果。在乳腺癌的分子生物学方面取得了重大进展，这应该会改善 MBC 的预后。在不久的将来，更多的治愈可能性可能成为一个可实现的目标。
