Yoneto Toshihiko, Hasumi Kenichiro, Fujii Yuzo, Takahashi Nobukazu, Seki Natsuki, Yoshimoto Takayuki, Takeda Yasutaka
Department of Breast Surgery, Hijirigaoka Hospital, Tama, Japan.
Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.
Transl Cancer Res. 2022 Oct;11(10):3903-3911. doi: 10.21037/tcr-22-1363.
In recent years, a number of agents possessing novel mechanisms, such as cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors and PIK3CA inhibitors, have been developed for the treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor type negative (HER2-) advanced or recurrent breast cancer. As a result, the treatment strategies for advanced or recurrent breast cancer have changed significantly. The combination of CDK 4/6 inhibitors administration and endocrine therapy is now widely used in the treatment of HR+ HER2- recurrent breast cancer with improved outcomes. In 2021, abemaciclib was approved as post-operative adjuvant combination therapy with endocrine therapy for HR+ HER2- advanced breast cancer and is expected to suppress postoperative recurrence. A range of new agents are being developed in addition to CDK4/6 inhibitors that provided more options of treatment strategies for advanced or recurrent breast cancer, which in turn could improve outcomes. However, the prognosis for the recurrent HR+ HER2- breast cancer remains poor, overall survival (OS) is still very low and a complete cure is difficult even with the treatments.
In 1998, 24 years ago, neoadjuvant chemotherapy (NAC) and the concept of subtypes were not even widespread, the number of available drugs was far fewer than today, the clinical treatment guidelines had not been established. Nevertheless, we experienced a case of HR+ HER2- advanced breast cancer, stage IIIB at the initial diagnosis, which was consistently treated with the aim of complete cure and with the various treatments available at the time, resulting in long-term survival. 24 years have passed since the initial surgery, the patient has continued to do well despite repeated recurrences and remissions.
We report here a case of long-term survival in advanced breast cancer of 24 years after surgery, and remark for future treatment strategies that not bound by the conventional treatment policy that emphasizes quality of life without aiming for complete cure.
近年来，已开发出多种具有新作用机制的药物，如细胞周期蛋白依赖性激酶4/6（CDK 4/6）抑制剂和PIK3CA抑制剂，用于治疗激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）的晚期或复发性乳腺癌。因此，晚期或复发性乳腺癌的治疗策略发生了显著变化。CDK 4/6抑制剂与内分泌治疗联合目前广泛用于HR+ HER2-复发性乳腺癌的治疗，疗效有所改善。2021年，阿贝西利被批准作为HR+ HER2-晚期乳腺癌术后辅助内分泌联合治疗药物，有望抑制术后复发。除CDK4/6抑制剂外，一系列新药物正在研发中，为晚期或复发性乳腺癌提供了更多治疗策略选择，进而可能改善疗效。然而，HR+ HER2-复发性乳腺癌的预后仍然很差，总生存期（OS）仍然很低，即使经过治疗也很难实现完全治愈。
1998年，也就是24年前，新辅助化疗（NAC）和亚型的概念甚至还不普遍，可用药物数量远少于现在，临床治疗指南也尚未确立。尽管如此，我们还是遇到了一例HR+ HER2-晚期乳腺癌患者，初诊时为IIIB期，一直以完全治愈为目标并采用当时可用的各种治疗方法进行治疗，最终实现了长期生存。自初次手术以来已过去24年，尽管病情反复复发和缓解，患者情况一直良好。
我们在此报告一例晚期乳腺癌术后24年长期生存的病例，并对未来的治疗策略提出看法，即不受限于强调生活质量而不追求完全治愈的传统治疗策略。
