Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
Drugs. 2017 Aug;77(12):1313-1336. doi: 10.1007/s40265-017-0774-5.
In the last decade, the systemic treatment approach for patients with early breast cancer has partly shifted from adjuvant treatment to neoadjuvant treatment. Systemic treatment administration started as a 'one size fits all' approach but is currently customized according to each breast cancer subtype. Systemic treatment in a neoadjuvant setting is at least as effective as in an adjuvant setting and has several additional advantages. First, it enables response monitoring and provides prognostic information; second, it downstages the tumor, allowing for less extensive surgery, improved cosmetic outcomes, and reduced postoperative complications such as lymphedema; and third, it enables early development of new treatment strategies by using pathological complete remission as a surrogate outcome of event-free and overall survival. In this review we give an overview of the current standard of neoadjuvant systemic treatment strategies for the three main subtypes of breast cancer: hormone receptor-positive, triple-negative, and human epidermal growth factor receptor 2-positive. Additionally, we summarize drugs that are under investigation for use in the neoadjuvant setting.
在过去的十年中，早期乳腺癌患者的系统治疗方法已部分从辅助治疗转向新辅助治疗。系统治疗的应用最初是一种“一刀切”的方法，但目前根据每个乳腺癌亚型进行了定制。新辅助治疗中的系统治疗至少与辅助治疗一样有效，并且具有几个额外的优点。首先，它能够进行反应监测并提供预后信息；其次，它使肿瘤降级，允许进行更广泛的手术，改善美容效果，并减少术后并发症，如淋巴水肿；最后，它通过将病理完全缓解用作无事件和总生存的替代终点，从而能够早期开发新的治疗策略。在这篇综述中，我们概述了目前三种主要乳腺癌亚型（激素受体阳性、三阴性和人表皮生长因子受体 2 阳性）的新辅助系统治疗策略的标准。此外，我们还总结了正在研究用于新辅助治疗的药物。
