Conforti Fabio, Pala Laura, De Pas Tommaso, Zattarin Emma, Catania Chiara, Cocorocchio Emilia, Rossi Giovanna, Laszlo Daniele, Colleoni Marco, Zambelli Alberto, Hortobagyi Gabriel N, Cortes Javier, Piccart Martine J, Dowsett Mitch, Gelber Richard D, Viale Giuseppe
Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Clin Cancer Res. 2024 Mar 15;30(6):1093-1103. doi: 10.1158/1078-0432.CCR-23-1836.
After decades of research, improving the efficacy of adjuvant endocrine therapy (ET) for early-stage breast cancer becomes increasingly difficult. Beyond technological breakthroughs and the availability of new classes of drugs, further improvement of adjuvant ET will require applying a rigorous research approach in poorly investigated areas. We critically discuss some key principles that should inform future research to improve ET efficacy, including identifying specific subgroups of patients who can benefit from escalating or de-escalating approaches, optimizing available and new treatment strategies for different clinical contexts, and dissecting the direct and indirect biological effects of therapeutic interventions. Four main issues regarding adjuvant ET were identified as relevant areas, where a better application of such principles can provide positive results in the near future: (i) tailoring the optimal duration of adjuvant ET, (ii) optimizing ovarian function suppression for premenopausal women, (iii) dissecting the biological effects of estrogen receptor manipulation, and (iv) refining the selection of patients to candidate for treatments escalation.
经过数十年的研究，提高早期乳腺癌辅助内分泌治疗（ET）的疗效变得越来越困难。除了技术突破和新型药物的可得性之外，辅助ET的进一步改善将需要在研究较少的领域采用严格的研究方法。我们批判性地讨论了一些关键原则，这些原则应为未来提高ET疗效的研究提供指导，包括确定可从强化或降阶梯方法中获益的特定患者亚组、针对不同临床情况优化现有和新的治疗策略，以及剖析治疗干预的直接和间接生物学效应。关于辅助ET的四个主要问题被确定为相关领域，在这些领域更好地应用这些原则有望在不久的将来取得积极成果：（i）确定辅助ET的最佳持续时间，（ii）优化绝经前女性的卵巢功能抑制，（iii）剖析雌激素受体操纵的生物学效应，以及（iv）完善治疗升级候选患者的选择。
