Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal.
Ann Oncol. 2012 Sep;23 Suppl 10:x237-42. doi: 10.1093/annonc/mds348.
Neoadjuvant therapy (NT) has become a valuable research tool for the incorporation of alternative cytotoxic agents, as well as new biological therapies, into anthracycline and taxane chemotherapy-based regimens. Her-2-positive disease is predictive of higher pathological complete response (pCR) to neoadjuvant chemotherapy and trastuzumab. Benefits were also seen for the combination of trastuzumab with lapatinib or pertuzumab, suggesting that dual blockage of the HER-2 will probably emerge as the new standard. Triple-negative phenotype is also predictive of high pCR to NT, but the prognosis of patients whose tumours do not achieve a pCR after neoadjuvant chemotherapy with anthracyclines and taxanes is dismal. Currently, it is recommended to use the same chemotherapy regimens as in non-triple-negative disease. The suggested benefit of neoadjuvant platinum, mainly in BRCA1-related cancers, needs to be confirmed in large randomized trials. Bevacizumab combined with neoadjuvant chemotherapy yields increased pCR compared with non-bevacizumab treatment, in large randomized data recently published. One study suggested higher benefit in triple-negative tumours. Long-term follow-up of these trials is needed to understand the role of bevacizumab treatment in BC and its important to find predictive biomarkers of response to this drug.
新辅助治疗 (NT) 已成为将替代细胞毒性药物以及新型生物疗法纳入蒽环类和紫杉烷类化疗方案的有价值的研究工具。Her-2 阳性疾病预示着对新辅助化疗和曲妥珠单抗的更高病理完全缓解 (pCR)。曲妥珠单抗联合拉帕替尼或帕妥珠单抗也显示出获益，这表明 HER-2 的双重阻断可能成为新的标准。三阴性表型也预示着对 NT 的高 pCR，但蒽环类和紫杉烷类新辅助化疗后未能达到 pCR 的患者预后较差。目前，建议使用与非三阴性疾病相同的化疗方案。新辅助铂类的建议获益，主要在 BRCA1 相关癌症中，需要在大型随机试验中得到证实。贝伐珠单抗联合新辅助化疗与非贝伐珠单抗治疗相比，可提高 pCR，这是最近发表的大型随机数据的结果。一项研究表明，三阴性肿瘤的获益更高。需要对这些试验进行长期随访，以了解贝伐珠单抗治疗在 BC 中的作用，并找到对该药物反应的预测性生物标志物非常重要。
