Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany.
Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Lancet. 2017 Mar 18;389(10074):1134-1150. doi: 10.1016/S0140-6736(16)31891-8. Epub 2016 Nov 17.
Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.
乳腺癌是全球最常见的三种癌症之一。早期乳腺癌被认为具有潜在的可治愈性。过去几年,治疗方法取得了实质性进展,无论是局部区域治疗还是全身治疗,治疗强度都有所降低;避免过度治疗和治疗不足已成为主要关注点。治疗方案遵循治愈意图,需要在多学科环境中做出决策,同时考虑分子亚型和局部肿瘤负荷。对于所有患者来说,原发性常规手术不再是最佳选择。在三阴性和 HER2 阳性早期乳腺癌中,新辅助治疗已成为常用选择。根据临床肿瘤亚型,治疗骨干包括内分泌治疗、抗 HER2 靶向治疗和化疗。在转移性乳腺癌中,治疗目标是延长生存期和维持生活质量。内分泌治疗和联合治疗的进展,以及针对 HER2 的靶向治疗,以及新的靶向治疗的前景,使得转移性乳腺癌的长期疾病控制成为越来越现实的前景。
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