Schmidt M, Koelbl H
Department of Obstetrics and Gynecology, Johannes Gutenberg-University, Mainz, Germany.
Minerva Ginecol. 2012 Feb;64(1):53-65.
Despite living in an era of progressively improved molecular characterization of breast cancer with novel prognostic and predictive tests as well as increased use of targeted therapies, adjuvant chemotherapy is still a cornerstone in the treatment of early breast cancer. Numerous clinical trials of adjuvant chemotherapy without trastuzumab have clearly shown that the effectiveness depends not only on the mere application of new substances (e.g., taxanes) but at least equally important on the way to utilize them. At present, standard adjuvant chemotherapy should include anthracyclines, taxanes and cyclophosphamide. Docetaxel is best used in three weekly intervals, while paclitaxel should be delivered either weekly or dose-dense every two weeks with G-CSF support. In high risk breast cancer patients with more than three involved axillary lymph nodes, an intensified dose-dense and sequential approach leads to significantly improved survival. Other approaches to improve the efficacy of adjuvant chemotherapy employ the incorporation of additional substances like capecitabine. Conversely, investigators trying to de-escalate adjuvant chemotherapy implemented taxane-containing but anthracycline-free chemotherapy. Altogether, these new approaches are awaiting further confirmatory clinical trials before they should be regarded as standard of care in early breast cancer.
尽管生活在一个乳腺癌分子特征通过新型预后和预测性检测不断改善、靶向治疗使用日益增加的时代，但辅助化疗仍是早期乳腺癌治疗的基石。众多不含曲妥珠单抗的辅助化疗临床试验清楚表明，疗效不仅取决于新药物（如紫杉烷类）的单纯应用，至少同样重要的是使用这些药物的方式。目前，标准辅助化疗应包括蒽环类、紫杉烷类和环磷酰胺。多西他赛最好每三周给药一次，而紫杉醇应每周给药或在粒细胞集落刺激因子（G-CSF）支持下每两周密集给药一次。在腋窝淋巴结转移超过三个的高危乳腺癌患者中，强化的密集序贯治疗方法可显著提高生存率。其他提高辅助化疗疗效的方法包括加入卡培他滨等其他药物。相反，试图降低辅助化疗强度的研究者采用了含紫杉烷但不含蒽环类的化疗。总之，这些新方法在被视为早期乳腺癌的标准治疗之前，尚需进一步的验证性临床试验。
