Matikas Alexios, Foukakis Theodoros, Bergh Jonas
a Department of Oncology-Pathology , Karolinska Institutet and University Hospital , Stockholm , Sweden.
Acta Oncol. 2017 Sep;56(9):1143-1151. doi: 10.1080/0284186X.2017.1329593. Epub 2017 May 24.
The introduction of adjuvant chemotherapy following surgery for early breast cancer (BC) and its integration into routine clinical practice has consistently improved clinical outcomes. Since the addition of other agents to the contemporary standard of care containing an anthracycline, cyclophosphamide and a taxane has not lead to further prolongation of survival, subsequent efforts concentrated on escalating the administered doses and reducing the time interval between chemotherapy cycles. These strategies have been extensively evaluated in randomized trials and dose dense chemotherapy is now recommended by clinical practice guidelines.
Eligible trials were identified by searching the EMBASE, Pubmed, Scopus and Cochrane Library databases, as well as conference papers. The findings, shortcomings and impact of these studies are presented and critically discussed.
Although a large number of randomized trials has established the value of adjuvant chemotherapy, important questions remain unanswered. Ongoing research focuses on omitting treatment in good risk patients, identifying patients most likely to benefit from a dose dense approach and on administering personalized doses such as in tailored dose chemotherapy.
Adjuvant chemotherapy for early BC is an evolving art. Further optimizations could potentially improve outcomes for a patient subset and spare others from unnecessary treatment-related toxicity.
早期乳腺癌（BC）术后辅助化疗的引入及其纳入常规临床实践持续改善了临床结局。由于在包含蒽环类药物、环磷酰胺和紫杉烷的当代标准治疗方案中添加其他药物并未进一步延长生存期，后续努力集中在提高给药剂量和缩短化疗周期之间的时间间隔。这些策略已在随机试验中得到广泛评估，目前临床实践指南推荐剂量密集化疗。
通过检索EMBASE、Pubmed、Scopus和Cochrane图书馆数据库以及会议论文来确定符合条件的试验。呈现并批判性地讨论了这些研究的结果、缺点和影响。
尽管大量随机试验已证实辅助化疗的价值，但重要问题仍未得到解答。正在进行的研究集中在对低风险患者省略治疗、确定最可能从剂量密集方法中获益的患者以及给予个性化剂量，如在定制剂量化疗中。
早期BC的辅助化疗是一门不断发展的艺术。进一步优化可能会改善一部分患者的结局，并使其他患者免受不必要的治疗相关毒性。
