Department of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, H4J 1C5, Montreal, Quebec, Canada.
Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B), 1, rue Heger-Bordet, 1000 Brussels, Belgium.
Nat Rev Clin Oncol. 2017 Nov;14(11):669-681. doi: 10.1038/nrclinonc.2017.96. Epub 2017 Aug 1.
No biomarker beyond HER2 itself, which suffers from a low positive predictive value, has demonstrated clinical utility in breast cancer, despite numerous attempts to improve treatment tailoring for the growing number of anti-HER2 targeted therapies. This prompted us to examine the body of evidence, using a systematic approach, to identify putative predictive biomarkers in HER2-positive breast cancer, and discuss the hitherto failure to address the needs of patients. In the future, it is hoped immune-based biomarkers will predict benefit from anti-HER2 treatments in the neoadjuvant and adjuvant settings. In advanced-stage disease, the quantification of tumour heterogeneity using molecular-imaging technology has generated informative data on the success or failure of the antibody-drug conjugate T-DM1. Treatment tailoring remains a high priority, in cost-constrained health-care systems, but such tailoring will require a dramatic shift in the way translational research is being conducted, with the establishment of large, easily accessible, and well-annotated databases of candidate predictive biomarkers. Single-centre biomarker research should become a thing of the past.
除了 HER2 本身之外，没有任何生物标志物具有临床实用性，尽管已经尝试了多种方法来改进针对越来越多的抗 HER2 靶向治疗药物的治疗方案，但 HER2 阳性乳腺癌的阳性预测值仍然较低。这促使我们使用系统的方法来检查证据，以确定 HER2 阳性乳腺癌中潜在的预测性生物标志物，并讨论迄今为止未能满足患者需求的问题。在未来，希望基于免疫的生物标志物能够预测新辅助和辅助治疗中抗 HER2 治疗的获益。在晚期疾病中，使用分子成像技术对肿瘤异质性进行定量，为抗体药物偶联物 T-DM1 的成功或失败提供了有价值的数据。在成本受限的医疗保健系统中，治疗方案的制定仍然是重中之重，但这种方案的制定需要在转化研究的方式上发生重大转变，建立大型、易于访问和充分注释的候选预测性生物标志物数据库。单中心生物标志物研究应该成为过去。
