Department of experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
Medical Oncology, IDI-IRCCS, Rome, Italy.
Breast Cancer (Dove Med Press). 2010 Oct 4;2:45-58. doi: 10.2147/BCTT.S6519.
Although rare, male breast cancer (MBC) remains a substantial cause for morbidity and mortality in men. Based on age frequency distribution, age-specific incidence rate pattern, and prognostic factor profiles, MBC is considered similar to postmenopausal breast cancer (BC). Compared with female BC (FBC), MBC cases are more often hormonal receptor (estrogen receptor/progesterone receptor [ER/PR]) positive and human epidermal growth factor receptor 2 (HER2) negative. Treatment of MBC patients follows the same indications as female postmenopausal with surgery, systemic therapy, and radiotherapy. To date, ER/PR and HER2 status provides baseline predictive information used in selecting optimal adjuvant/neoadjuvant therapy and in the selection of therapy for recurrent or metastatic disease. HER2 represents a very interesting molecular target and a number of compounds (trastuzumab [Herceptin®; F. Hoffmann-La Roche, Basel, Switzerland] and lapatinib [Tykerb®, GlaxoSmithKline, London, UK]) are currently under clinical evaluation. Particularly, trastuzumab, a monoclonal antibody which selectively binds the extracellular domain of HER2, has become an important therapeutic agent for women with HER2-positive (HER2+) BC. Currently, data regarding the use of trastuzumab in MBC patients is limited and only few case reports exist. In all cases, MBC patients received trastuzumab concomitantly with other drugs and no severe toxicity above grade 3 was observed. However, MBC patients that would be candidate for trastuzumab therapy (ie, HER2+/ER+ or HER2+/ER- MBCs) represent only a very small percentage of MBC cases. This is noteworthy, when taking into account that trastuzumab is an important and expensive component of systemic BC therapy. Since there is no data supporting the fact that response to therapy is different for men or women, we concluded that systemic therapy in MBC should be considered on the same basis as for FBC. Particularly in male patients, trastuzumab should be considered exclusively for advanced disease or high-risk HER2+ early BCs. On the other hand, lapatinib (Tykerb), a novel oral dual tyrosine kinase inhibitor that targets both HER2 and epidermal growth factor receptor, may represent an interesting and promising therapeutic agent for trastuzumab-resistant MBC patients.
虽然罕见，但男性乳腺癌（MBC）仍是男性发病和死亡的重要原因。基于年龄频率分布、特定年龄的发病率模式和预后因素特征，MBC 被认为与绝经后乳腺癌（BC）相似。与女性乳腺癌（FBC）相比，MBC 患者更常为激素受体（雌激素受体/孕激素受体 [ER/PR]）阳性和人表皮生长因子受体 2（HER2）阴性。MBC 患者的治疗遵循与女性绝经后相同的适应证，包括手术、全身治疗和放疗。迄今为止，ER/PR 和 HER2 状态为选择最佳辅助/新辅助治疗以及选择复发性或转移性疾病的治疗提供了基线预测信息。HER2 是一个非常有趣的分子靶点，许多化合物（曲妥珠单抗[赫赛汀®；罗氏，巴塞尔，瑞士]和拉帕替尼[泰克布®，葛兰素史克，伦敦，英国]）正在进行临床评估。特别是曲妥珠单抗，一种选择性结合 HER2 细胞外结构域的单克隆抗体，已成为治疗 HER2 阳性（HER2+）BC 女性的重要治疗药物。目前，关于 MBC 患者使用曲妥珠单抗的数据有限，仅存在少数病例报告。在所有情况下，MBC 患者均同时接受曲妥珠单抗和其他药物治疗，未观察到 3 级以上的严重毒性。然而，适合曲妥珠单抗治疗的 MBC 患者（即 HER2+/ER+或 HER2+/ER-MBC）仅占 MBC 患者的很小一部分。这一点很重要，因为曲妥珠单抗是全身 BC 治疗的重要且昂贵的组成部分。由于没有数据支持男性或女性对治疗的反应不同，我们得出结论，MBC 的全身治疗应与 FBC 相同。特别是在男性患者中，曲妥珠单抗仅应考虑用于晚期疾病或高危 HER2+早期 BC。另一方面，拉帕替尼（泰克布）是一种新型口服双重酪氨酸激酶抑制剂，可靶向 HER2 和表皮生长因子受体，可能是曲妥珠单抗耐药的 MBC 患者的一种有趣且有前途的治疗药物。
