Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Department of Surgery, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA.
Breast Cancer Res Treat. 2024 Feb;203(3):407-417. doi: 10.1007/s10549-023-07149-x. Epub 2023 Oct 25.
Extension of adjuvant endocrine therapy beyond five years confers only modest survival benefit in breast cancer patients and carries risk of toxicities. This systematic review investigates the role of biomarker tests in predicting the clinical response to an extension of endocrine therapy.
We searched Ovid MEDLINE, Ovid Embase, Global Index Medicus, and the Cochrane Central Register of Controlled Trials using an iterative approach to identify full-text articles related to breast cancer, endocrine therapy, and biomarkers.
Of the 1,217 unique reports identified, five studies were deemed eligible. Four investigated the Breast Cancer Index (BCI) assay in three distinct study populations. These studies consistently showed that BCI score was predictive of response to extended endocrine therapy among 1,946 combined patients, who were predominately non-Hispanic white and postmenopausal.
Evidence in the setting of predictive tests for extended endocrine therapy is sparse. Most relevant studies investigated the use of BCI, but these study populations were largely restricted to a single age, race, and ethnicity group. Future studies should evaluate a variety of biomarkers in diverse populations. Without sufficient evidence, physicians and patients face a difficult decision in balancing the benefits and risks of endocrine therapy extension.
辅助内分泌治疗延长超过五年仅为乳腺癌患者提供适度的生存获益，并伴有毒性风险。本系统评价研究了生物标志物检测在预测内分泌治疗延长的临床反应中的作用。
我们采用迭代方法在 Ovid MEDLINE、Ovid Embase、全球医学索引和 Cochrane 对照试验中心注册库中进行检索，以确定与乳腺癌、内分泌治疗和生物标志物相关的全文文章。
在 1217 份独特的报告中，有 5 项研究被认为符合条件。其中 4 项研究调查了乳腺癌指数（BCI）检测在三个不同的研究人群中的作用。这些研究一致表明，BCI 评分可预测 1946 例联合患者对延长内分泌治疗的反应，这些患者主要是非西班牙裔白人且绝经后。
关于预测性检测延长内分泌治疗的证据有限。大多数相关研究都调查了 BCI 的使用，但这些研究人群主要局限于单一的年龄、种族和民族群体。未来的研究应在不同人群中评估各种生物标志物。由于缺乏足够的证据，医生和患者在权衡内分泌治疗延长的获益和风险时面临着艰难的决策。
