Rapoport Bernardo L, Demetriou Georgia S, Moodley Shun D, Benn Carol A
The Medical Oncology Center of Rosebank, 129 Oxford Road, Parklands, Johannesburg, South Africa, PO Box 2040, 2121,
Curr Treat Options Oncol. 2014 Mar;15(1):86-98. doi: 10.1007/s11864-013-0266-0.
Systemic neoadjuvant chemotherapy is utilized along with surgery and radiotherapy for the management of patients with locally advanced breast cancer. The backbone of current chemotherapy regimens include anthracyclines and taxanes given either sequentially or concurrently for up to 8 cycles. Neoadjuvant treatment benefits include in vivo assessment of response to treatment with reduction in the extent of primary and regional metastases. Neoadjuvant chemotherapy for operable breast cancer is used in women who desire breast conservation surgery who are not candidates for such treatment at the time of the diagnosis. The use of neoadjuvant treatment in patients, who present with operable breast cancer, shows equivalent survival outcome compared with adjuvant breast cancer treatment. Several prospective studies have evaluated the role of trastuzumab in combination with neoadjuvant chemotherapy in patients with Her2-positive disease. The addition of trastuzumab to neoadjuvant chemotherapy is associated with improvement of the complete clinical and pathological complete response to therapy and significantly improved event-free survival and overall survival. Dual Her2 blockade is emerging as a new approach to improve pathological complete response rates and therefore survival. To date, in triple-negative breast cancer, there are no predictive markers to identify potential treatment targets. Triple-negative patients who achieve a pathological complete response have more favorable outcome compared with those with residual disease following neoadjuvant treatment. The choice of optimal chemotherapy regimen and the duration of treatment have been studied extensively in the neoadjuvant setting. No consensus has been developed thus far. Following work done with anthracycline and CMF treatments in neoadjuvant chemotherapy, recent studies in locally advanced breast cancer focus on the addition of new and target agents. All of these trials are based on well-established regimes used in the adjuvant setting. Successful use of neoadjuvant chemotherapy requires a coordinated multidisciplinary approach.
全身新辅助化疗与手术和放疗联合用于局部晚期乳腺癌患者的治疗。目前化疗方案的主要药物包括蒽环类和紫杉类，可序贯或同时给药，最多8个周期。新辅助治疗的益处包括对治疗反应的体内评估以及原发灶和区域转移灶范围的缩小。可手术乳腺癌的新辅助化疗用于希望保留乳房手术但在诊断时不适合此类治疗的女性。对可手术乳腺癌患者使用新辅助治疗与辅助性乳腺癌治疗相比，显示出相当的生存结果。几项前瞻性研究评估了曲妥珠单抗联合新辅助化疗在HER2阳性疾病患者中的作用。在新辅助化疗中添加曲妥珠单抗与改善临床完全缓解和病理完全缓解以及显著提高无事件生存期和总生存期相关。双重HER2阻断正在成为提高病理完全缓解率从而改善生存率的一种新方法。迄今为止，在三阴性乳腺癌中，尚无预测标志物来识别潜在的治疗靶点。与新辅助治疗后有残留疾病的患者相比，达到病理完全缓解的三阴性患者有更有利的预后。在新辅助治疗中，对最佳化疗方案的选择和治疗持续时间进行了广泛研究。迄今为止尚未达成共识。在新辅助化疗中使用蒽环类和CMF治疗后，最近针对局部晚期乳腺癌的研究集中在添加新的靶向药物。所有这些试验均基于辅助治疗中使用的成熟方案。成功使用新辅助化疗需要多学科协调方法。
