Nardin Simone, Ruelle Tommaso, Giannubilo Irene, Del Mastro Lucia
U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Department of Internal Medicine and Medical Sciences, School of Medicine, University of Genova, Genova, Italy.
Tumori. 2024 Jun;110(3):162-167. doi: 10.1177/03008916231216830. Epub 2023 Dec 19.
Breast cancer is the most common cancer in women, and luminal breast cancer is the predominant subtype, characterized by the presence of estrogen receptors and/or progesterone receptors in tumor cells. Adjuvant endocrine therapy is the pivotal approach in the management of luminal early breast cancer. Hence, new therapeutic approaches have been studied during the last few years, especially in patients with high risk of recurrence.Here we provide a summary of the most recent clinical trials evaluating adjuvant treatment in hormone-receptors-positive early breast cancer. First, the main cornerstone is related to the role of extended endocrine treatment, which has been widely investigated to access a benefit in disease-free survival and overall survival (only the GIM4 trial has positive feedback about survival) and to tailor the treatment according to patient compliance. The results highlighted an advantage in extending the use of endocrine treatment for at least seven full years, considering aromatase inhibitors as principal drugs. Second, the shift of CDK4/6 inhibitors (CDK4/6i) from advanced to early setting reported positive outcomes, with favorable results from MonarchE and NATALEE trials, using Abemaciclib and Ribociclib respectively, even if non-negligible toxicities have been reported. Last, the use of PARP inhibitors for BRCA1/2 mutated patients has been evaluated in the OlympiA trial (Olaparib), observing a comparable benefit between hormone-receptors-positive and triple-negative early breast cancer.However, more data are still required to better select patients that could benefit more from CDK4/6i considering side effects too, and sequential treatments are still not codified.
乳腺癌是女性中最常见的癌症，而管腔型乳腺癌是主要的亚型，其特征是肿瘤细胞中存在雌激素受体和/或孕激素受体。辅助内分泌治疗是管腔型早期乳腺癌治疗的关键方法。因此，在过去几年中一直在研究新的治疗方法，尤其是在复发风险高的患者中。在此，我们总结了评估激素受体阳性早期乳腺癌辅助治疗的最新临床试验。首先，主要基石与延长内分泌治疗的作用有关，这已被广泛研究以获取无病生存期和总生存期的益处（只有GIM4试验对生存期有积极反馈），并根据患者的依从性调整治疗方案。结果表明，将内分泌治疗至少延长整整七年具有优势，将芳香化酶抑制剂作为主要药物。其次，CDK4/6抑制剂（CDK4/6i）从晚期治疗向早期治疗的转变报告了积极结果，MonarchE和NATALEE试验分别使用阿贝西利和瑞博西尼取得了良好结果，尽管也报告了不可忽视的毒性。最后，在OlympiA试验（奥拉帕利）中评估了PARP抑制剂对BRCA1/2突变患者的使用，观察到激素受体阳性和三阴性早期乳腺癌之间具有可比的益处。然而，仍需要更多数据以更好地选择可能从CDK4/6i中获益更多的患者，同时也要考虑副作用，并且序贯治疗仍未规范化。
