Ban Marija, Petrić Miše Branka, Vrdoljak Eduard
Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia.
Breast Care (Basel). 2020 Dec;15(6):560-569. doi: 10.1159/000511883. Epub 2020 Oct 28.
Trastuzumab significantly improves outcomes in early HER2-positive breast cancer, irrespectively of any prognostic or predictive factors. Unfortunately, about a quarter of patients receiving neoadjuvant trastuzumab experience disease recurrence, revealing the unquestionable need for further improvement of treatment outcomes.
Adding HER2 blockade to adjuvant trastuzumab with pertuzumab and neratinib improves invasive disease-free survival (IDFS), particularly for those at highest risk of recurrence. A shift toward a neoadjuvant strategy for patients with a higher risk of recurrence could result in further treatment optimization. For patients without a pathological complete response (pCR) after the neoadjuvant part of the therapy, a switch to adjuvant trastuzumab emtansine significantly improves IDFS and distant recurrence-free survival and shows a trend towards improved overall survival (OS). On the other hand, for low-risk patients, chemotherapy deescalation should be strongly considered with the use of trastuzumab monotherapy as an anti-HER2 backbone.
Neoadjuvant therapy should be offered for a significant proportion of HER2-positive early breast cancer patients with a higher risk of recurrence. Postneoadjuvant treatment should be tailored according to the initial stage of disease and the response to neoadjuvant treatment.
无论任何预后或预测因素如何，曲妥珠单抗均可显著改善早期HER2阳性乳腺癌的预后。不幸的是，约四分之一接受新辅助曲妥珠单抗治疗的患者会出现疾病复发，这表明无疑需要进一步改善治疗效果。
在辅助曲妥珠单抗治疗中加入HER2阻断剂帕妥珠单抗和奈拉替尼可提高无侵袭性疾病生存期（IDFS），特别是对于那些复发风险最高的患者。对于复发风险较高的患者，转向新辅助治疗策略可能会进一步优化治疗。对于在新辅助治疗阶段后未达到病理完全缓解（pCR）的患者，改用辅助曲妥珠单抗恩美曲妥珠单抗可显著提高IDFS和远处无复发生存期，并显示出总生存期（OS）改善的趋势。另一方面，对于低风险患者，应强烈考虑降低化疗强度，使用曲妥珠单抗单药治疗作为抗HER2的基础治疗。
对于很大一部分复发风险较高的HER2阳性早期乳腺癌患者，应提供新辅助治疗。辅助治疗应根据疾病的初始阶段和对新辅助治疗的反应进行调整。
