Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, MA, 02215, Boston, USA.
Curr Treat Options Oncol. 2023 Jun;24(6):594-610. doi: 10.1007/s11864-023-01082-3. Epub 2023 Apr 15.
For high-risk early-stage hormone-receptor-positive, HER2-negative breast cancer (HR + /HER2 - EBC), short- and long-term recurrence risks remain substantial despite local control with surgery and radiation and systemic treatment with chemotherapy and endocrine therapy (ET). Recent trials have provided new strategies for reducing recurrence. The monarchE trial demonstrated that adding 2 years of adjuvant abemaciclib to ET improves invasive disease-free survival (iDFS) and distant recurrence-free survival (DRFS). In the OlympiA trial for high-risk disease in patients with germline BRCA1/BRCA2 mutations, adding 1 year of olaparib to ET improved iDFS, DRFS, and overall survival (OS). In addition, for premenopausal women with high-risk tumors, long-term follow-up of the SOFT, ASTRRA, TEXT, ABCSG-12, and HOBOE trials supports the role of ovarian function suppression (OFS), in combination with adjuvant tamoxifen or aromatase inhibition (AI). For postmenopausal women with high-risk tumors, extended-duration AI for at least 7 years should be used with zoledronic acid. Given the remaining recurrence risk even with these interventions and with the ongoing development of new strategies for HR + disease, patients with high-risk EBC should be encouraged to participate in clinical trials, such as trials of immunotherapy, novel oral estrogen receptor alpha (ERα)-targeting agents, antibody-drug conjugates (ADCs), and trials guided by measurements of minimal residual disease (MRD).
对于高风险早期激素受体阳性、HER2 阴性乳腺癌（HR+/HER2-EBC），尽管通过手术和放疗进行局部控制以及通过化疗和内分泌治疗（ET）进行全身治疗，但短期和长期复发风险仍然很大。最近的试验为降低复发风险提供了新的策略。monarchE 试验表明，在 ET 中添加 2 年的辅助 abemaciclib可改善无侵袭性疾病生存（iDFS）和远处无复发生存（DRFS）。在 OlympiA 试验中，对于具有种系 BRCA1/BRCA2 突变的高危疾病患者，在 ET 中添加 1 年的奥拉帕利可改善 iDFS、DRFS 和总生存（OS）。此外，对于高危肿瘤的绝经前妇女，SOFT、ASTRRA、TEXT、ABCSG-12 和 HOBOE 试验的长期随访支持卵巢功能抑制（OFS）的作用，与辅助他莫昔芬或芳香化酶抑制剂（AI）联合使用。对于高危肿瘤的绝经后妇女，应使用唑来膦酸延长至少 7 年的 AI。考虑到即使采用这些干预措施仍存在残留的复发风险，以及 HR+疾病新策略的不断发展，应鼓励高危 EBC 患者参加临床试验，如免疫疗法、新型口服雌激素受体 alpha（ERα）靶向药物、抗体药物偶联物（ADC）以及基于微小残留病（MRD）测量的试验。
