García-Saenz José Ángel, Rodríguez-Lescure Álvaro, Cruz Josefina, Albanell Joan, Alba Emilio, Llombart Antonio
Instituto de Investigación Sanitaria Hospital Clínico San Carlos, IdISSC, Calle Profesor Martín Lagos, S/N, 28040, Madrid, Spain.
Hospital General Universitario de Elche, FISABIO, Alicante, Spain.
Target Oncol. 2025 Mar;20(2):191-213. doi: 10.1007/s11523-024-01125-1. Epub 2025 Jan 13.
Metastatic triple-negative breast cancer has a poor prognosis and poses significant therapeutic challenges. Until recently, limited therapeutic options have been available for patients with advanced disease after failure of first-line chemotherapy. The aim of this review is to assess the current evidence supporting second-line treatment options in patients with metastatic triple-negative breast cancer. Evidence was reviewed from controlled clinical trials in which eribulin, vinorelbine, capecitabine, gemcitabine, gemcitabine plus carboplatin, fam-trastuzumab-deruxtecan, sacituzumab govitecan, olaparib, and talazoparib were used in the second-line treatment for metastatic breast cancer, either as study drugs or as comparators. The benefit of treatment was evaluated using the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale. Based on the evidence review, sacituzumab govitecan was identified as the preferred second-line treatment option for patients with metastatic triple-negative breast cancer, supported by clinical evidence and consensus across international clinical guidelines. Olaparib and talazoparib are of use in patients with human epidermal growth factor receptor 2-negative metastatic breast cancer and germline BRCA1/2 mutations. Exploratory data for fam-trastuzumab-deruxtecan suggest a survival benefit in human epidermal growth factor receptor 2-low, hormone-receptor-negative patients, but further solid evidence is required. Other chemotherapies with lower European Society for Medical Oncology-Magnitude of Clinical Benefit Scale scores may continue to be useful in highly selected patients.
转移性三阴性乳腺癌预后较差，带来了重大的治疗挑战。直到最近，一线化疗失败后的晚期疾病患者可用的治疗选择仍然有限。本综述的目的是评估支持转移性三阴性乳腺癌患者二线治疗选择的现有证据。我们回顾了对照临床试验的证据，这些试验中，艾日布林、长春瑞滨、卡培他滨、吉西他滨、吉西他滨联合卡铂、fam-曲妥珠单抗-德曲妥珠单抗、戈沙妥珠单抗、奥拉帕利和他拉唑帕利被用于转移性乳腺癌的二线治疗，要么作为研究药物，要么作为对照药物。使用欧洲医学肿瘤学会临床获益程度量表评估治疗的益处。基于证据回顾，戈沙妥珠单抗被确定为转移性三阴性乳腺癌患者首选的二线治疗选择，这得到了国际临床指南的临床证据和共识的支持。奥拉帕利和他拉唑帕利可用于人表皮生长因子受体2阴性的转移性乳腺癌和胚系BRCA1/2突变的患者。fam-曲妥珠单抗-德曲妥珠单抗的探索性数据表明，在人表皮生长因子受体2低表达、激素受体阴性的患者中可能有生存获益，但需要进一步确凿的证据。欧洲医学肿瘤学会临床获益程度量表评分较低的其他化疗药物在经过高度选择的患者中可能仍然有用。
