Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Chin Clin Oncol. 2021 Dec;10(6):59. doi: 10.21037/cco-21-122.
The purpose of this article review is to discuss the current adjuvant approach for human epidermal growth factor receptor 2 (HER2) gene amplification or overexpression inflammatory breast cancer (IBC), as well as promising therapies to improve the prognosis of these patients, with the main focus on the high risk setting of patients with residual disease after neoadjuvant therapy.
IBC is a rare and very aggressive form of breast cancer. HER2+ is more frequent in IBC than in non-IBC. A combined multimodality therapy is essential for better outcomes in non-metastatic HER2+ IBC patients, including neoadjuvant chemotherapy, with dual HER2 blockade, local therapy with surgery and radiotherapy, and adjuvant systemic therapy, which is defined on the basis of pathological response and hormone receptor (HR) status. Dual HER2 blockade with trastuzumab and pertuzumab combined to neoadjuvant chemotherapy improved the pathological complete response (pCR) rate. However, HER+ IBC patients with residual disease at surgery have a high risk of recurrence and death.
A comprehensive review was conducted through Medline/PubMed database, ClinicalTrials.gov, and conference abstracts.
Escalation of adjuvant therapy for patients with HER2+ IBC with residual invasive disease after neoadjuvant therapy is recommended. Adjuvant ado-trastuzumab emtansine and neratinib, for HR+ disease, are the most recent advances in this setting, with a clinically meaningful improvement in invasive disease-free survival (iDFS). Despite the clinical advances, reducing the risk of central nervous system recurrence remains an unmet need. Several promising clinical trials are ongoing to improve patients' prognosis in this high-risk of recurrence setting.
本文旨在探讨人表皮生长因子受体 2（HER2）基因扩增或过表达炎性乳腺癌（IBC）的辅助治疗方法，以及改善这些患者预后的有前途的治疗方法，重点关注新辅助治疗后残留疾病的高危患者。
IBC 是一种罕见且极具侵袭性的乳腺癌。HER2+在 IBC 中的发生率高于非 IBC。非转移性 HER2+ IBC 患者需要联合多模式治疗，包括新辅助化疗、双 HER2 阻断、手术和放疗的局部治疗以及辅助全身治疗，这是基于病理反应和激素受体（HR）状态来定义的。曲妥珠单抗和帕妥珠单抗联合新辅助化疗的双 HER2 阻断提高了病理完全缓解（pCR）率。然而，手术时仍有残留疾病的 HER+ IBC 患者复发和死亡风险较高。
通过 Medline/PubMed 数据库、ClinicalTrials.gov 和会议摘要进行了全面综述。
建议对新辅助治疗后仍有残留浸润性疾病的 HER2+ IBC 患者进行强化辅助治疗。对于 HR+疾病，辅助 ado-trastuzumab emtansine 和 neratinib 是该领域的最新进展，在无侵袭性疾病生存（iDFS）方面有显著改善。尽管取得了临床进展，但降低中枢神经系统复发的风险仍是一个未满足的需求。目前正在进行多项有前途的临床试验，以改善该高复发风险患者的预后。
