Ye Hunan, Lin Guang, Wang Xiaojia
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
Transl Breast Cancer Res. 2024 Jul 25;5:20. doi: 10.21037/tbcr-24-16. eCollection 2024.
Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR/HER2) breast cancer (BC) is the most prevalent subtype of all BCs. The primary treatment modality is endocrine therapy (ET). Traditional adjuvant ET for early-stage breast cancer (EBC) has undergone extensive exploration and is relatively well-established. However, patients at high risk of recurrence may still experience early relapse, necessitating consideration of intensified adjuvant ET to reduce recurrence risk. The objective of this narrative review is to examine various strategies for intensifying adjuvant ET in EBC, thoroughly analyze key clinical studies, and summarize the most effective treatment approaches supported by current evidence-based medicine. Furthermore, it addresses unresolved challenges that necessitate further refinement and investigation.
As of March 2024, a comprehensive literature search, compilation, and analysis were conducted across PubMed, Baidu Scholar, ClinicalTrials.gov, and relevant academic conferences.
There are numerous methods to intensify adjuvant ET: (I) combining ovarian function suppression (OFS) to reduce estrogen levels in the body and induce a state of artificial menopause to enhance the efficacy of ET; (II) individual extension of the duration of ET based on patients' varying risks of recurrence, with high-risk patients covering two peak recurrence periods; (III) the addition of cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) can significantly extend invasive disease-free survival and reduce the risk of recurrence, serving as the main intensive treatment for high-risk patients; (IV) combination with bone-modifying drugs (BMD) can significantly reduce rates of bone metastasis and slightly enhance prognosis but is not commonly used in adjuvant settings; (V) combined with poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors, current studies only show a trend towards benefit in HR patients with germline mutations; more data are still needed to support its clinical benefit. This narrative review examines various strategies for intensifying adjuvant ET in EBC, critically evaluates key clinical studies, and summarizes the most effective treatment approaches supported by current evidence-based medicine. Furthermore, it addresses unresolved challenges that necessitate further refinement and investigation.
In the context where traditional adjuvant ET is relatively well-established, the emergence of novel ET has notably addressed issues of endocrine resistance more effectively. Various intensified adjuvant ET has shown potential in further reducing recurrence risk among high-risk patients. However, additional research and time are essential to determine the optimal approaches for intensified adjuvant ET.
激素受体阳性/人表皮生长因子受体2阴性（HR/HER2）乳腺癌是所有乳腺癌中最常见的亚型。主要治疗方式为内分泌治疗（ET）。早期乳腺癌（EBC）的传统辅助内分泌治疗已进行了广泛探索且相对成熟。然而，复发风险高的患者仍可能出现早期复发，因此有必要考虑强化辅助内分泌治疗以降低复发风险。本叙述性综述的目的是研究强化EBC辅助内分泌治疗的各种策略，深入分析关键临床研究，并总结当前循证医学支持的最有效治疗方法。此外，还探讨了有待解决的挑战，这些挑战需要进一步完善和研究。
截至2024年3月，在PubMed、百度学术、ClinicalTrials.gov及相关学术会议上进行了全面的文献检索、汇编和分析。
强化辅助内分泌治疗有多种方法：（I）联合卵巢功能抑制（OFS）以降低体内雌激素水平，诱导人工绝经状态，从而提高内分泌治疗的疗效；（II）根据患者不同的复发风险，个体化延长内分泌治疗时间，高危患者覆盖两个复发高峰期；（III）添加细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）可显著延长无侵袭性疾病生存期并降低复发风险，是高危患者的主要强化治疗方法；（IV）与骨改良药物（BMD）联合使用可显著降低骨转移率并稍改善预后，但在辅助治疗中不常用；（V）与聚（腺苷二磷酸 - 核糖）聚合酶（PARP）抑制剂联合使用，目前研究仅显示对携带种系突变的HR患者有获益趋势；仍需更多数据支持其临床获益。本叙述性综述研究了强化EBC辅助内分泌治疗的各种策略，批判性评估了关键临床研究，并总结了当前循证医学支持的最有效治疗方法。此外，还探讨了有待解决的挑战，这些挑战需要进一步完善和研究。
在传统辅助内分泌治疗相对成熟的背景下，新型内分泌治疗的出现更有效地解决了内分泌耐药问题。各种强化辅助内分泌治疗在进一步降低高危患者复发风险方面显示出潜力。然而，确定强化辅助内分泌治疗的最佳方法还需要更多研究和时间。
