Department of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Drugs. 2022 Sep;82(14):1437-1451. doi: 10.1007/s40265-022-01781-5. Epub 2022 Oct 7.
Breast cancer is the most common malignancy and the second leading cause of cancer-related mortality in the United States (US). Most patients are diagnosed with early-stage disease; however, there is still a need to prevent recurrences that often present as incurable metastatic disease. The treatment landscape of early-stage breast cancer is evolving rapidly. The immune checkpoint inhibitor pembrolizumab is approved in combination with neoadjuvant chemotherapy for the treatment of high-risk triple-negative breast cancer (TNBC). The cyclin-dependent kinase (CDK) 4 and 6 inhibitor abemaciclib is approved for adjuvant treatment of patients with high-risk hormone receptor (HR)-positive disease. While adjuvant olaparib has shown significant improvement in outcomes for patients with pathogenic/likely pathogenic BRCA1/2 mutations and high-risk human epidermal growth factor receptor 2 (HER2)-negative breast cancer, and is approved in this setting. For the HER2-positive subtype, the post-neoadjuvant therapy can be tailored based on the response to neoadjuvant chemotherapy and HER2-targeted agents. In this narrative review, we summarize the most recent approvals for early-stage breast cancer as well as frequently encountered clinical challenges utilizing these medications.
乳腺癌是美国最常见的恶性肿瘤和癌症相关死亡的第二大原因。大多数患者被诊断为早期疾病；然而，仍需要预防经常表现为不可治愈的转移性疾病的复发。早期乳腺癌的治疗领域正在迅速发展。免疫检查点抑制剂 pembrolizumab 已被批准与新辅助化疗联合用于治疗高危三阴性乳腺癌 (TNBC)。细胞周期蛋白依赖性激酶 (CDK) 4 和 6 抑制剂 abemaciclib 已被批准用于高危激素受体 (HR) 阳性疾病的辅助治疗。虽然奥拉帕利在具有致病性/可能致病性 BRCA1/2 突变和高危人表皮生长因子受体 2 (HER2) 阴性乳腺癌的患者中显示出显著改善的结局，并且在这种情况下被批准使用，但辅助 olaparib。对于 HER2 阳性亚型，可以根据新辅助化疗和 HER2 靶向药物的反应来调整辅助治疗方案。在本叙述性综述中，我们总结了早期乳腺癌的最新批准情况以及使用这些药物时经常遇到的临床挑战。
