Le Tourneau Christophe
Institut Curie, département d’oncologie médicale, unité d’investigations cliniques, 25, rue d’Ulm,75248 Paris Cedex 05, France.
Bull Cancer. 2011 Apr;98(4):445-9. doi: 10.1684/bdc.2011.1345.
The incidence of brain metastases is particularly high in HER2-overexpressing (HER2+) breast cancer. Several hypotheses have been raised trying to explain this peculiar phenomenon, including a better control of extra-cerebral metastases with HER2-targeting agents, but also the own effect of HER2+ tumor cells that may have a marked brain tropism. In this context, the development of prevention strategies is highly relevant. After a brief description of the natural history of HER2+ breast cancer, three different prevention strategies are discussed in this article, including a secondary prevention strategy by systematic screening of brain metastases, and two primary prevention strategies with prophylactic cerebral irradiation and the optimisation of the adjuvant treatment. None of these strategies has been validated to date. A prolonged follow-up is crucial in order to detail the natural history of HER2+ breast cancers and to evaluate the impact of new treatments on the incidence of brain metastases.
脑转移在人表皮生长因子受体2过表达（HER2+）的乳腺癌中发生率特别高。人们提出了几种假说试图解释这一特殊现象，包括使用HER2靶向药物能更好地控制脑外转移，以及HER2+肿瘤细胞本身可能具有明显的脑嗜性。在这种情况下，预防策略的制定具有高度相关性。在简要描述HER2+乳腺癌的自然病史后，本文讨论了三种不同的预防策略，包括通过系统筛查脑转移的二级预防策略，以及预防性脑照射和优化辅助治疗的两种一级预防策略。迄今为止，这些策略均未得到验证。延长随访时间对于详细了解HER2+乳腺癌的自然病史以及评估新治疗方法对脑转移发生率的影响至关重要。
