Perez Edith A, Rugo Hope S, Vahdat Linda T
University of California San Francisco, San Francisco, California.
Clin Adv Hematol Oncol. 2013;11(10 Suppl 16):1-18; quiz 19.
The treatment of metastatic breast cancer continues to be a challenging area for medical oncologists. Breast tumors are classified into several groups based on immunohistochemistry: those that are estrogen-receptor–positive and human epidermal growth factor receptor 2 (HER2)-negative; those that are HER2-positive and either estrogen-receptor–positive or estrogen-receptor–negative; and those that are negative for the estrogen receptor, progesterone receptor, and HER2 (known as triple-negative). These biologic factors are an important component of the risk assessment and treatment strategy. Management goals for advanced disease are to target treatment to the specific biology in a more effective way, and to add in targeted agents that may improve the effectiveness of standard therapies, such as hormone therapy and chemotherapy. There are several new therapies that are changing outcome for patients with metastatic disease, such as eribulin, pertuzumab, and ado-trastuzumab emtansine. It is critical to understand the appropriate dosing schedules of novel agents and how best to combine them with standard therapy. Ongoing clinical trials are evaluating new treatment approaches, as well as ways to identify biologic subsets that might benefit from particular therapies. Investigational agents include glembatumumab vedotin, neratinib, and margetuximab.
转移性乳腺癌的治疗对于肿瘤内科医生而言仍然是一个具有挑战性的领域。乳腺肿瘤根据免疫组化被分为几组：雌激素受体阳性且人表皮生长因子受体2（HER2）阴性的肿瘤；HER2阳性且雌激素受体阳性或雌激素受体阴性的肿瘤；以及雌激素受体、孕激素受体和HER2均为阴性的肿瘤（即三阴性肿瘤）。这些生物学因素是风险评估和治疗策略的重要组成部分。晚期疾病的管理目标是以更有效的方式针对特定生物学特性进行治疗，并加入可能提高标准疗法（如激素疗法和化疗）疗效的靶向药物。有几种新疗法正在改变转移性疾病患者的治疗结果，如艾瑞布林、帕妥珠单抗和ado曲妥珠单抗 emtansine。了解新型药物的合适给药方案以及如何将它们与标准疗法最佳地联合使用至关重要。正在进行的临床试验正在评估新的治疗方法以及识别可能从特定疗法中获益的生物学亚组的方法。研究药物包括戈利昔单抗、来那替尼和玛格妥昔单抗。
