Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2021 Apr;28(4):2111-2119. doi: 10.1245/s10434-020-09480-9. Epub 2021 Jan 23.
While historically breast cancer has been treated with primary surgery followed by adjuvant therapy, the delivery of systemic therapy in the neoadjuvant setting has become increasingly common, especially for triple-negative and HER2-positive breast cancer. The initial motivations for pursuing neoadjuvant chemotherapy (NAC) were decreasing the tumor burden in the breast and axilla to enable de-escalation of surgery, and use the strategy to advance drug development. While these remain of interest, recent trials have additionally demonstrated survival advantages from escalation of systemic treatment in patients with residual disease, and new studies are testing de-escalation of systemic therapy based on pathologic response. Thus, response information to NAC has become pivotal to guide adjuvant treatment recommendations, and has resulted in NAC being the preferred approach for most HER2-positive and triple-negative breast cancers. Herein, we review select landmark trials that have paved the way for the use of chemotherapy in the neoadjuvant setting for breast cancer.
虽然乳腺癌的传统治疗方法是首先进行主要手术，然后进行辅助治疗，但新辅助治疗中系统治疗的应用已变得越来越普遍，尤其是对于三阴性和 HER2 阳性乳腺癌。最初采用新辅助化疗（NAC）的动机是降低乳房和腋窝中的肿瘤负担，以实现手术的降级，以及利用该策略推进药物开发。虽然这些仍然很重要，但最近的试验还证明了在残留疾病患者中升级系统治疗的生存优势，并且新的研究正在测试基于病理反应的系统治疗降级。因此，对 NAC 的反应信息对于指导辅助治疗建议至关重要，并导致 NAC 成为大多数 HER2 阳性和三阴性乳腺癌的首选方法。在此，我们回顾了一些具有里程碑意义的试验，这些试验为化疗在乳腺癌新辅助治疗中的应用铺平了道路。
