Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
Semin Oncol. 2020 Oct;47(5):249-258. doi: 10.1053/j.seminoncol.2020.07.007. Epub 2020 Aug 20.
Advancements in the care for patients with early stage HER2-positive breast cancer is a story of incremental successes aimed at optimizing efficacy and reducing the toxicities of administered therapies. HER2 drives an aggressive breast cancer subtype that represents 15%-20% of breast cancers, for which HER2-targeted therapy is very active. In addition to trastuzumab, pertuzumab, neratinib, and ado-trastuzumab emtansine have been approved in recent years for the treatment of high-risk early stage HER2-positive breast cancer. As a result of both a high response rate to neoadjuvant therapy and the opportunity for response-adapted adjuvant therapy, the treatment paradigm has evolved so that most patients with stage II and III disease now receive neoadjuvant therapy. Additionally, the efficacy of HER2-therapy allows for de-escalation of treatment in many patients with stage I disease. As a result, multidisciplinary evaluation is essential for the optimal care of patients with HER2-positive breast cancer. Important areas of further research include tailoring the duration and intensity of therapy based on disease risk and response to neoadjuvant therapy. This article will review the evaluation of patients with early stage HER2-positive breast cancer and provide an evidence- and guideline-based summary of risk-based treatment strategies.
早期 HER2 阳性乳腺癌患者治疗的进步是一个不断取得成功的故事，旨在优化疗效并降低所给予治疗的毒性。HER2 驱动侵袭性乳腺癌亚型，占乳腺癌的 15%-20%，针对 HER2 的靶向治疗非常有效。除曲妥珠单抗外，近年来已批准帕妥珠单抗、奈拉替尼和恩美曲妥珠单抗用于高危早期 HER2 阳性乳腺癌的治疗。由于新辅助治疗的高反应率和适应反应的辅助治疗机会，治疗模式已经发展，现在大多数 II 期和 III 期疾病患者都接受新辅助治疗。此外，HER2 治疗的疗效允许许多 I 期疾病患者降低治疗强度。因此，多学科评估对于 HER2 阳性乳腺癌患者的最佳治疗至关重要。进一步研究的重要领域包括根据疾病风险和新辅助治疗反应来调整治疗的持续时间和强度。本文将综述早期 HER2 阳性乳腺癌患者的评估，并提供基于风险的治疗策略的循证和指南总结。
