Medical Oncology, AC Camargo Cancer Center, Rua Pires Da Mota, São Paulo, Brazil.
Fellow of the European School of Oncology, Milan, Italy.
Expert Rev Anticancer Ther. 2021 Nov;21(11):1237-1251. doi: 10.1080/14737140.2021.1960160. Epub 2021 Sep 7.
: For decades, endocrine therapy has been the cornerstone of management for luminal breast cancer. Despite the substantial benefit derived by patients from endocrine therapy, primary and secondary resistances to endocrine therapy are serious clinical issues.: Today, in the advanced setting, three distinct classes of targeted agents mTOR, CDK 4/6, and PI3K inhibitors, are approved for use. CDK 4/6 inhibitors have improved outcomes substantially, changing the natural history of advanced luminal breast cancer. Current studies seek to bring CDK 4/6 inhibitors to the early setting. This review will cover all available data on target therapy combinations with endocrine therapy for both the early and advanced settings, including approved drugs and agents in development.: Combined endocrine and target therapy has changed the landscape in advanced disease. In early disease, it is possible to have a large impact, particularly in patients with higher risk of relapse. Trials like ADAPTCYCLE seek to leverage neoadjuvant data to de-escalate treatment, substituting chemotherapy for CDK 4/6 inhibitors. In advanced diseases, studies such as PADA-1 point toward a future in which ctDNA will be used to define management before clinical progression occurs.
几十年来，内分泌治疗一直是腔乳腺癌治疗的基石。尽管患者从内分泌治疗中获得了实质性的益处，但内分泌治疗的原发性和继发性耐药仍然是严重的临床问题。如今，在晚期治疗中，已有三种不同类别的靶向药物 mTOR、CDK4/6 和 PI3K 抑制剂被批准使用。CDK4/6 抑制剂的应用显著改善了患者的预后，改变了晚期腔乳腺癌的自然病程。目前的研究旨在将 CDK4/6 抑制剂应用于早期治疗。本文综述了早期和晚期内分泌治疗联合靶向治疗的所有相关数据，包括已批准的药物和正在开发的药物。联合内分泌和靶向治疗已经改变了晚期疾病的治疗格局。在早期疾病中，这种治疗方法有可能产生重大影响，特别是对于复发风险较高的患者。ADAPTCYCLE 等试验旨在利用新辅助治疗的数据来减少治疗强度，用 CDK4/6 抑制剂替代化疗。在晚期疾病中，PADA-1 等研究表明，在临床进展发生之前，ctDNA 将被用于确定治疗方案。
