Women's Cancers Program, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Oncology (Williston Park). 2012 Jul;26(7):652-9, 663.
Breast cancer brain metastases (BCBMs) are the second most frequent secondary central nervous system metastases following those associated with non-small-cell lung cancer. It is increasingly evident that BCBM arises as a function of the biology of the primary tumor and the metastatic niche, which combine to create a unique microenvironment in the brain impacting both metastatic colonization and therapeutic response. Clinical outcomes are improving for BCBM patients as a result of modern combinatorial therapies, challenging the traditionally nihilistic approach to this patient subgroup. This review will focus on the breast cancer subtypes with the highest incidence of BCBM-human epidermal growth factor receptor 2 (HER2)-positive breast cancer, and triple-negative (estrogen receptor [ER]-negative, progesterone receptor [PR]-negative, and HER2-negative) breast cancer (TNBC)-and will characterize differences in the clinical behavior of brain metastases that arise from these different subtypes. We will also highlight some of the recent preclinical studies that may shed light on the biological mechanisms and mediators underlying brain metastases. Finally, we will review published and current prospective trials of systemic therapies specifically for BCBM, including novel pathway-specific therapies.
乳腺癌脑转移（BCBMs）是继非小细胞肺癌相关转移之后第二常见的继发性中枢神经系统转移。越来越明显的是，BCBM 是原发性肿瘤和转移部位生物学的功能，它们共同在大脑中创造了一个独特的微环境，影响转移定植和治疗反应。由于现代联合治疗，BCBM 患者的临床结果得到了改善，这对这一患者亚组的传统消极治疗方法提出了挑战。本综述将重点关注脑转移发生率最高的乳腺癌亚型——人表皮生长因子受体 2（HER2）阳性乳腺癌和三阴性（雌激素受体 [ER] 阴性、孕激素受体 [PR] 阴性和 HER2 阴性）乳腺癌（TNBC），并描述源于这些不同亚型的脑转移的临床行为差异。我们还将重点介绍一些最近的临床前研究，这些研究可能揭示脑转移的生物学机制和介导因素。最后，我们将综述专门针对 BCBM 的系统治疗的已发表和当前前瞻性试验，包括新的靶向治疗。
