Department of Oncology & Hematology, Cantonal Hospital, Rorschacherstrasse 95, 9007 St Gallen, Switzerland.
Expert Rev Anticancer Ther. 2013 Feb;13(2):165-78. doi: 10.1586/era.12.172.
The addition of adjuvant chemotherapy in early breast cancer improves overall survival by approximately 10%. Recommendations favor the use of anthracyclines and taxanes in patients with luminal B disease, while the use of an anthracycline, taxane and alkylating agent is recommended in triple-negative disease. In luminal B disease, the addition of chemotherapy to endocrine treatment depends on estrogen receptor expression and overall risk. Chemotherapy is not recommended in most patients with luminal A (highly hormone-sensitive and low proliferation) breast cancer. A major controversy is the addition of adjuvant chemotherapy to endocrine treatment in patients with estrogen receptor-positive breast cancer. In some of these patients, multigene signatures such as the 21-gene recurrence score may be a useful addition to histopathology. The introduction of molecular subtypes and gene signatures improves the complexity of early breast cancer treatment, and individual institutes have to find their policy based on their histopathological information and the availability of gene signatures.
辅助化疗在早期乳腺癌中的应用可使总生存期提高约 10%。对于 luminal B 型疾病的患者，建议使用蒽环类药物和紫杉类药物，而对于三阴性疾病，则建议使用蒽环类药物、紫杉类药物和烷化剂。在 luminal B 型疾病中，内分泌治疗中是否加用化疗取决于雌激素受体表达和整体风险。大多数 luminal A 型（高激素敏感性和低增殖）乳腺癌患者不推荐化疗。一个主要的争议是在雌激素受体阳性乳腺癌患者中，辅助化疗是否应该与内分泌治疗联合应用。在这些患者中，21 基因复发评分等多基因标志物可能对组织病理学有一定的辅助作用。分子亚型和基因标志物的引入增加了早期乳腺癌治疗的复杂性，各个机构必须根据其组织病理学信息和基因标志物的可用性来制定自己的治疗策略。
