IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy.
IRCCS Humanitas Research Hospital, Breast Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy.
Crit Rev Oncol Hematol. 2021 Apr;160:103280. doi: 10.1016/j.critrevonc.2021.103280. Epub 2021 Mar 2.
Indication for neoadjuvant chemotherapy (NACT) in HR+/HER2-negative tumors is controversial. Pathological complete response (pCR) rates range from 0 to 18 % while breast-conserving surgery (BCS) is achievable in up to 60 % of tumors. No pathological feature definitely predicts pCR; lobular and molecular luminal A tumors are less likely to achieve pCR although experiencing better outcomes. Luminal B subtype, high proliferation, lack of progesterone receptor, high tumor-infiltrating lymphocytes are positively associated with increased pCR rates but worse outcomes and the prognostic role of pCR is inconsistent across studies. Molecular intrinsic subtyping and genomic signatures appear as more accurate predictors of benefit from NACT, but larger studies are needed. Anthracycline and taxane-based chemotherapy remains the standard NACT; however, CDK 4/6 inhibitors and immune checkpoint inhibitors are under evaluation. In conclusion, NACT may be proposed for luminal tumors requiring downsizing for BCS after multidisciplinary evaluation, provided that other contraindications to BCS are excluded.
在 HR+/HER2-阴性肿瘤中，新辅助化疗（NACT）的适应证存在争议。病理完全缓解（pCR）率为 0 至 18%，而保乳手术（BCS）在多达 60%的肿瘤中是可行的。没有任何病理特征能明确预测 pCR；尽管腔镜型和分子型 luminal A 肿瘤更有可能获得较好的结局，但它们不太可能达到 pCR。Luminal B 亚型、高增殖、孕激素受体缺乏、高肿瘤浸润淋巴细胞与 pCR 率的增加以及较差的结局相关，pCR 的预后作用在不同的研究中并不一致。分子内在亚型和基因组特征似乎是预测 NACT 获益的更准确指标，但需要更大规模的研究。蒽环类和紫杉类化疗仍然是 NACT 的标准方案；然而，CDK4/6 抑制剂和免疫检查点抑制剂正在评估中。总之，在多学科评估后，对于需要降期以行 BCS 的 luminal 肿瘤，可以考虑行 NACT，但需排除 BCS 的其他禁忌证。
