Van de Wiel Mick, Dockx Yanina, Van den Wyngaert Tim, Stroobants Sigrid, Tjalma Wiebren A A, Huizing Manon T
Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital - University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital - University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium; Molecular Imaging Center Antwerp, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:144-156. doi: 10.1016/j.ejogrb.2016.12.014. Epub 2016 Dec 14.
The management of locally advanced breast cancer (LABC) remains a major clinical issue, despite progress achieved in diagnosis and therapy. Preoperative or neoadjuvant therapy has gained interest since breast cancer has been regarded as a systemic disease. Comparing adjuvant versus neoadjuvant treatment, the neoadjuvant approach offers the advantage of downstaging the disease and testing the efficacy of therapy administered to patients. A large number of clinical trials have attempted to define the optimal neoadjuvant treatment, but little attention has been paid to the sequence of chemotherapy. Moreover, the integration of antibodies against Human Epidermal Receptor-2 (HER-2) and other biological therapies that may improve the long-term control of breast cancer patients, have a special clinical interest. In this review, we will discuss these topics attempting to answer the questions why, when and which regimen to use for patients with LABC. Especially, the introduction of the platina derivatives in neoadjuvant trials with their exceptional high pathological complete response rates are challenging to rethink the optimal treatment options in early and locally advanced breast cancer.
尽管在诊断和治疗方面取得了进展，但局部晚期乳腺癌（LABC）的管理仍然是一个主要的临床问题。自从乳腺癌被视为一种全身性疾病以来，术前或新辅助治疗受到了关注。与辅助治疗相比，新辅助治疗方法具有使疾病降期以及测试给予患者的治疗疗效的优势。大量临床试验试图确定最佳的新辅助治疗方案，但对化疗顺序的关注较少。此外，针对人表皮受体2（HER-2）的抗体与其他可能改善乳腺癌患者长期控制的生物疗法的联合应用具有特殊的临床意义。在本综述中，我们将讨论这些主题，试图回答为什么、何时以及对LABC患者使用哪种方案的问题。特别是，铂类衍生物在新辅助试验中的引入及其极高的病理完全缓解率，促使人们重新思考早期和局部晚期乳腺癌的最佳治疗选择。
