Rastogi Priya, Geyer Charles E, Mamounas Eleftherios P, DeMichele Angela
From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Texas Southwestern Medical Center, Dallas, TX; MD Anderson Cancer Center Orlando, Orlando, FL; University of Pennsylvania, Philadelphia, PA.
Am Soc Clin Oncol Educ Book. 2013:73-9. doi: 10.14694/EdBook_AM.2013.33.73.
Preoperative therapy allows for a higher rate of breast conserving surgery and has been shown equivalent to adjuvant therapy. Preoperative therapy provides an opportunity to obtain insights into breast cancer biology and to accelerate the evaluation of new therapies. Clinical trials have shown that women who achieve a pathologic complete response (pCR) have substantially improved outcomes compared with those who do not achieve a pCR. The U.S. Food and Drug Administration (FDA) meta-analysis demonstrated that the association of pCR and long-term outcomes is greater in women with aggressive breast cancer subtypes. In patients with HER2+ breast cancer, the addition of trastuzumab to chemotherapy in the neoadjuvant setting has doubled pCR and correlated with improved outcomes. Clinical trials will evaluate tailoring the use of radiation therapy in patients who have received neoadjuvant therapy. Trials have established neoadjuvant endocrine therapy as a valid treatment and research option for ER-rich breast cancer. The neoadjuvant setting allows for evaluation of endocrine therapies in combination with newer targeted therapies in the appropriate patient populations. The neoadjuvant setting provides opportunity to accelerate the evaluation of new agents, improve pCR rates, and identify predictive biomarkers for response. This setting provides the opportunity for screening new agents in combination with chemotherapy while obtaining serial biopsies to understand biology of response and resistance. Although current standard therapies provide substantial benefits for patients with a pCR, patients with residual disease are at substantial risk for disease recurrence. New agents are being evaluated in patients with high-risk residual disease following standard treatment regimens.
术前治疗可提高保乳手术率，且已证明其与辅助治疗等效。术前治疗为深入了解乳腺癌生物学特性以及加速新疗法评估提供了契机。临床试验表明，达到病理完全缓解（pCR）的女性与未达到pCR的女性相比，其预后有显著改善。美国食品药品监督管理局（FDA）的荟萃分析表明，在侵袭性乳腺癌亚型的女性中，pCR与长期预后的关联更大。在HER2阳性乳腺癌患者中，新辅助治疗时在化疗中添加曲妥珠单抗使pCR率翻倍，并与改善的预后相关。临床试验将评估在接受新辅助治疗的患者中调整放射治疗的使用。试验已确定新辅助内分泌治疗是雌激素受体丰富型乳腺癌的一种有效治疗和研究选择。新辅助治疗环境允许在合适的患者群体中评估内分泌治疗与更新的靶向治疗联合使用的情况。新辅助治疗环境为加速新药评估、提高pCR率以及识别反应预测生物标志物提供了机会。这种环境为在联合化疗的同时筛选新药提供了机会，同时进行系列活检以了解反应和耐药的生物学机制。尽管目前的标准疗法为达到pCR的患者带来了显著益处，但有残留疾病的患者仍有很高的疾病复发风险。正在对接受标准治疗方案后有高危残留疾病的患者进行新药评估。
