Gampenrieder Simon P, Rinnerthaler Gabriel, Greil Richard
3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
J Oncol. 2013;2013:732047. doi: 10.1155/2013/732047. Epub 2013 Aug 20.
Traditionally, neoadjuvant treatment for breast cancer was preserved for locally advanced and inflammatory disease, converting an inoperable to a surgical resectable cancer. In recent years, neoadjuvant therapy has become an accepted treatment option also for lower tumor stages in order to increase the rate of breast conserving therapy and to reduce the extent of surgery. Furthermore, treatment response can be monitored, and therefore, patient compliance may be increased. Neoadjuvant trials, additionally, offer the opportunity to evaluate new treatment options in a faster way and with fewer patients than large adjuvant trials. Compared to the metastatic setting, the issue of acquired resistance and pretreatments, which may distort treatment efficacy, can be avoided. New trial designs like window-of-opportunity trials or postneoadjuvant trials provide the chance to identify tumor sensitivity or to overcome tumor resistance in early tumor stages. In particular, in HER2-positive breast cancer, the neoadjuvant approach yielded great successes. The dual HER2 blockade with trastuzumab and pertuzumab recently showed the highest pCR rates ever reported. Many new drugs are in clinical testing with the aim to further increase pCR rates. Whether this endpoint really represents a surrogate for long-term outcome is not answered yet and will be discussed in this review.
传统上，乳腺癌的新辅助治疗仅用于局部晚期和炎性疾病，将不可手术切除的癌症转变为可手术切除的癌症。近年来，新辅助治疗也已成为较低肿瘤分期患者可接受的治疗选择，以提高保乳治疗的比例并减少手术范围。此外，可监测治疗反应，因此可能提高患者的依从性。与大型辅助试验相比，新辅助试验还提供了以更快的速度、用更少的患者评估新治疗方案的机会。与转移性疾病情况相比，可以避免获得性耐药和预处理等可能影响治疗效果的问题。新的试验设计，如机会窗试验或新辅助后试验，为在肿瘤早期阶段识别肿瘤敏感性或克服肿瘤耐药性提供了机会。特别是在HER2阳性乳腺癌中，新辅助治疗方法取得了巨大成功。曲妥珠单抗和帕妥珠单抗的双重HER2阻断最近显示出了有史以来报道的最高的病理完全缓解（pCR）率。许多新药正在进行临床试验，目的是进一步提高pCR率。这个终点是否真的代表长期预后的替代指标尚未得到解答，将在本综述中进行讨论。
