Breast Center, Department of Obstetrics & Gynecology and CCCMunich, LMU University Hospital, Munich, Germany.
Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Cancer. 2022 Jun 1;128 Suppl 11:2209-2223. doi: 10.1002/cncr.34161.
The heterogeneity of hormone receptor (HR)-positive, HER2-negative early breast cancers reinforces the importance of individualized, risk-adapted treatment approaches. Numerous factors contribute to the risk for recurrence, including clinical tumor features, individual biomarkers, and genomic risk. Current standard approaches for patients with HR-positive, HER2-negative, early stage disease focus on endocrine therapy and chemotherapy. The specific treatment regimen and duration of adjuvant therapy should be selected based on accurate risk assessment, tolerability of available therapies, and consideration for patient preferences. For patients with high-risk features, such as highly proliferative tumors, large tumor size, and significant nodal involvement, the risk for recurrence remains clinically significant despite appropriate adjuvant treatment with current standards of care. This has driven investigation into novel treatment approaches, including the addition of cyclin-dependent kinase 4 and 6 inhibitors to adjuvant endocrine therapy. Cyclin-dependent kinase 4 and 6 inhibition has demonstrated significant efficacy in patients with high-risk, HR-positive, HER2-negative, nonmetastatic breast cancer and now offers a new strategy to greatly improve outcomes in this difficult to treat patient population.; LAY SUMMARY: Hormone receptor (HR)-positive, HER2-negative early breast cancers are highly diverse and need to be managed differently for individual patients. The use of adjuvant endocrine therapy and chemotherapy should be driven by a patient's risk for recurrence, preferences, and risk for side effects. Patients with high-risk tumors have a persistently elevated risk for recurrence despite current standards of care. Emerging cyclin-dependent kinase 4 and 6 inhibitors are highly effective when added to endocrine therapy in high-risk, HR-positive early breast cancer and have the potential to improve patient outcomes in this difficult to treat patient population.
激素受体（HR）阳性、HER2 阴性的早期乳腺癌具有高度异质性，这凸显了采用个体化、风险适应治疗方法的重要性。许多因素可增加复发风险，包括临床肿瘤特征、个体生物标志物和基因组风险。目前，HR 阳性、HER2 阴性、早期疾病患者的标准治疗方法侧重于内分泌治疗和化疗。辅助治疗的具体治疗方案和持续时间应根据准确的风险评估、现有治疗方法的耐受性以及患者偏好来选择。对于具有高危特征的患者，如高增殖性肿瘤、较大的肿瘤大小和明显的淋巴结受累，尽管采用当前标准治疗方法进行适当的辅助治疗，复发风险仍然具有临床意义。这推动了对新型治疗方法的研究，包括将细胞周期蛋白依赖性激酶 4 和 6 抑制剂添加到辅助内分泌治疗中。细胞周期蛋白依赖性激酶 4 和 6 抑制在高危、HR 阳性、HER2 阴性、非转移性乳腺癌患者中显示出显著疗效，现在为改善这一治疗困难的患者群体的结局提供了一种新策略。; 概要：HR 阳性、HER2 阴性的早期乳腺癌具有高度异质性，需要针对每位患者的具体情况进行不同的管理。辅助内分泌治疗和化疗的应用应根据患者的复发风险、偏好和副作用风险来驱动。尽管采用了当前的标准治疗方法，具有高危肿瘤的患者仍存在持续升高的复发风险。当将细胞周期蛋白依赖性激酶 4 和 6 抑制剂添加到高危 HR 阳性早期乳腺癌的内分泌治疗中时，这些抑制剂具有高度疗效，有可能改善这一治疗困难的患者群体的患者结局。
