Garrone Ornella, Ruatta Fiorella, Rea Carmen Giusy, Denaro Nerina, Ghidini Michele, Cauchi Carolina, Bareggi Claudia, Galassi Barbara, Merlano Marco C, Rosenfeld Roberto
Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Scientific Direction, Candiolo Cancer Institute, FPO-IRCCS Candiolo, 10060 Torino, Italy.
Cancers (Basel). 2024 Dec 13;16(24):4164. doi: 10.3390/cancers16244164.
Breast cancer is the most frequently diagnosed neoplasm all over the world and the second leading cause of cancer death in women. Breast cancer prognosis has significantly improved in the last years due to the advent of novel therapeutic options, both in the early and in advanced stages. However, the spread of the disease to the brain, accounting for 15-30% of the metastatic diagnoses, is challenging, and its poor prognosis represents an unmet medical need, leading to deterioration of quality of life and causing morbidity and mortality. Generally, triple-negative and HER2-positive breast cancer subtypes more frequently spread to the brain or in the leptomeningeal space. Consequently, according to international guidelines, several systemic treatments can be offered as a first option in some subsets of patients. However, a multidisciplinary approach is recommended to offer the most appropriate strategy to patients. Antibody-drug conjugates such as trastuzumab deruxtecan or sacituzumab govitecan along with small molecules have led to important achievements in the treatment of brain metastases from HER2-positive and triple-negative breast cancer. In this narrative review, we will focus on the molecular features leading to the development of brain metastases and explore the risk and the prognostic factors involved in the development of brain metastases. Finally, we will review the major achievements in the treatment landscape of brain metastases from breast cancer and novel medical approaches.
乳腺癌是全球最常被诊断出的肿瘤，也是女性癌症死亡的第二大主要原因。近年来，由于新型治疗方案的出现，无论是早期还是晚期乳腺癌的预后都有了显著改善。然而，疾病扩散至脑部（占转移诊断的15%-30%）具有挑战性，其预后较差代表了一种未被满足的医疗需求，会导致生活质量下降，并引发发病和死亡。一般来说，三阴性和HER2阳性乳腺癌亚型更常扩散至脑部或软脑膜间隙。因此，根据国际指南，在某些患者亚组中，几种全身治疗可作为首选。然而，建议采用多学科方法为患者提供最合适的策略。曲妥珠单抗德鲁昔单抗或戈沙妥珠单抗等抗体药物偶联物以及小分子药物在治疗HER2阳性和三阴性乳腺癌脑转移方面取得了重要成果。在这篇叙述性综述中，我们将聚焦于导致脑转移发生的分子特征，并探讨脑转移发生所涉及的风险和预后因素。最后，我们将回顾乳腺癌脑转移治疗领域的主要成就和新型医学方法。
