Division of Medical Oncology, McGill University Health Centre, Montreal, QC.
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, U.S.A.
Curr Oncol. 2014 Feb;21(1):e122-8. doi: 10.3747/co.21.1627.
In recent years, considerable attention has been paid to the role of neoadjuvant chemotherapy as a pluripotential test bed for the treatment of breast cancer. Although traditionally reserved to render inoperable disease operable, neoadjuvant chemotherapy is increasingly being used to improve the chance for breast-conserving surgery, to gain information on pathologic response rates for a more rapid assessment of new chemotherapy-biologic regimens, and also to study in vivo tumour sensitivity or resistance to the agent being used. Similarly, use of neoadjuvant endocrine treatment was also traditionally restricted to elderly or frail patients who were felt to be unsuitable for chemotherapy. It is therefore not surprising that, given the increasing realization of the pivotal role of endocrine therapy in patient care, there is enhanced interest in neoadjuvant endocrine therapy not only as a less-toxic alternative to chemotherapy, but also to assess tumour sensitivity or resistance to endocrine agents. The availability of newer endocrine manipulations and increasing evidence that the benefits of chemotherapy are frequently marginal in many hormone-positive patients is making endocrine therapy increasingly important in the clinical setting. The hope is that, one day, instead of preoperative endocrine therapy being restricted to the infirm and the elderly, it will be used in the time between biopsy diagnosis and surgery to predict which patients will or will not benefit from chemotherapy in the adjuvant setting.
近年来，新辅助化疗在乳腺癌治疗中的多潜能试验床作用引起了相当的关注。虽然新辅助化疗传统上被保留用于使不可手术的疾病变为可手术，但它越来越多地被用于提高保乳手术的机会，获得病理反应率的信息，以便更快速地评估新的化疗-生物治疗方案，并且还用于研究肿瘤对所用药物的体内敏感性或耐药性。同样，新辅助内分泌治疗的使用传统上也仅限于被认为不适合化疗的老年或体弱患者。因此，鉴于内分泌治疗在患者治疗中关键作用的认识不断提高，人们对新辅助内分泌治疗的兴趣增加也就不足为奇了，这不仅是一种毒性较小的化疗替代方法，而且还可以评估肿瘤对内分泌药物的敏感性或耐药性。新的内分泌干预措施的出现，以及越来越多的证据表明，在许多激素阳性患者中，化疗的益处往往微不足道，这使得内分泌治疗在临床环境中变得越来越重要。人们希望有一天，术前内分泌治疗不再局限于体弱和老年人，而是用于活检诊断和手术之间的时间，以预测哪些患者将从辅助化疗中受益，哪些患者不会受益。
