Medical Oncology Service, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Pompeu Fabra University, Barcelona, Spain.
Cancer Treat Rev. 2014 Feb;40(1):41-7. doi: 10.1016/j.ctrv.2013.04.002. Epub 2013 May 6.
Results of trials assessing the role of trastuzumab in the adjuvant setting in early breast cancer have brought a new standard of treatment to clinical practice. Nevertheless, some groups of patients are underrepresented in these trials and thus therapy should be planned based on incomplete information or lack of solid data. Two of these groups are high-risk HER2+ small tumours (<1cm) and elderly patients. In this review we aimed at addressing the most relevant data about these two populations underrepresented in clinical trials. HER2 overexpression or amplification confers a bad prognosis in patients with small breast tumours. Mammographic screening is increasing the early diagnosis. Taking into account that specific targeted adjuvant treatment can avoid relapses in 50% of HER2-positive patients, about 2 to 7% of relapses from small tumours could be avoided with the use of this treatment. Randomized and non-randomized trials support the idea that adjuvant therapies could improve clinical outcomes of ⩽1cm tumours. Adding a HER2-targeted treatment to chemotherapy may improve efficacy. Some recent data in the neo-adjuvant context suggest that, in some patients, aggressive chemotherapy treatment could be properly substituted by HER2-targeted therapy. In elderly women with HER2+ breast cancer, trastuzumab should be considered for adjuvant-treatment, particularly in those at higher risk of relapse, lack of extra risk factors for trastuzumab-associated cardiotoxicity, and having a prolonged estimated life expectancy. In addition to traditional anthracycline-based combinations commonly used in younger women, other options are the use of sequential chemotherapy, non-anthracycline containing regimes plus anti-HER2 therapies, combinations with hormonotherapy, or even anti-HER2 agents alone.
评估曲妥珠单抗在早期乳腺癌辅助治疗中作用的临床试验结果为临床实践带来了新的治疗标准。然而，这些试验中有些患者群体代表性不足，因此治疗方案应基于不完整的信息或缺乏确凿的数据来制定。其中两个群体是高风险 HER2+小肿瘤（<1cm）和老年患者。在这篇综述中，我们旨在讨论临床试验中代表性不足的这两个群体的最相关数据。HER2 过表达或扩增赋予了小乳房肿瘤患者不良的预后。乳房 X 线筛查正在增加早期诊断。考虑到特定的靶向辅助治疗可以避免 50%的 HER2 阳性患者复发，使用这种治疗方法可以避免 2%至 7%的小肿瘤复发。随机和非随机试验支持辅助治疗可以改善 ⩽1cm 肿瘤的临床结果的观点。添加针对 HER2 的治疗可以提高疗效。在新辅助环境中的一些最新数据表明，在某些患者中，侵袭性化疗治疗可以适当替代 HER2 靶向治疗。对于 HER2+乳腺癌的老年女性，应考虑将曲妥珠单抗用于辅助治疗，特别是在那些复发风险较高、缺乏曲妥珠单抗相关心脏毒性相关额外风险因素且预期寿命较长的患者中。除了在年轻女性中常用的传统蒽环类药物联合治疗外，其他选择包括序贯化疗、不含蒽环类药物的方案加抗 HER2 治疗、联合激素治疗，甚至单独使用抗 HER2 药物。
