Karihtala Peeter
Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Finland; Department of Oncology and Radiotherapy, Oulu University Hospital, Finland.
Acta Oncol. 2025 Jun 25;64:815-829. doi: 10.2340/1651-226X.2025.43645.
The prognosis for hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer has significantly improved over the past few decades. However, a substantial number of patients still face an elevated risk of recurrence. Due to the high prevalence and cumulative mortality of HR+/HER2- breast cancer, it poses a global health challenge.
This is a narrative review on the post-chemotherapy treatment options in patients with HR+/HER2- breast cancer.
Endocrine therapy remains the cornerstone of adjuvant treatment, with extended durations of tamoxifen and aromatase inhibitors demonstrating survival benefits. Several novel post-chemotherapy adjuvant treatments have recently been introduced for high-risk patients, and now most patients with HR+/HER2- breast cancer are eligible for non-endocrine adjuvant therapies. Bisphosphonates help to reduce bone recurrence and enhance overall survival in postmenopausal women, though the evidence remains somewhat inconsistent. CDK4/6 inhibitors abemaciclib and ribociclib have also emerged as adjuvant therapies, while the poly ADP ribose polymerase (PARP) inhibitor olaparib provides clinically meaningful benefits for patients with germline BRCA1/2 mutations.
Optimal patient selection for these often toxic treatments remains partially unclear and is the focus of intensive research. In the near future, monitoring ctDNA may enable treatment de-escalation for selected high-risk patients. The rise of perioperative immunological therapies, new CDK4-specific inhibitors, and targeted endocrine treatments can lead to a notably favorable prognosis for many previously high-risk HR+/HER2- breast cancers. Future research should prioritize predictive biomarkers and personalized approaches to optimize treatment efficacy, ensure more equal access to treatments, and minimize overtreatment.
在过去几十年中，激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性乳腺癌的预后有了显著改善。然而，仍有相当数量的患者面临复发风险升高的问题。由于HR+/HER2-乳腺癌的高发病率和累积死亡率，它构成了一项全球性的健康挑战。
这是一篇关于HR+/HER2-乳腺癌患者化疗后治疗选择的叙述性综述。
内分泌治疗仍然是辅助治疗的基石，延长他莫昔芬和芳香化酶抑制剂的使用时间显示出生存获益。最近已为高危患者引入了几种新型化疗后辅助治疗方法，现在大多数HR+/HER2-乳腺癌患者都有资格接受非内分泌辅助治疗。双膦酸盐有助于减少绝经后女性的骨复发并提高总生存率，尽管证据仍有些不一致。CDK4/6抑制剂阿贝西利和瑞博西尼也已成为辅助治疗药物，而聚ADP核糖聚合酶（PARP）抑制剂奥拉帕尼为携带胚系BRCA1/2突变的患者提供了具有临床意义的益处。
对于这些通常具有毒性的治疗方法，最佳的患者选择仍部分不明确，并且是深入研究的重点。在不久的将来，监测循环肿瘤DNA（ctDNA）可能会使部分高危患者的治疗降级。围手术期免疫治疗、新型CDK4特异性抑制剂和靶向内分泌治疗的兴起可使许多先前高危的HR+/HER2-乳腺癌患者获得明显更好的预后。未来的研究应优先考虑预测性生物标志物和个性化方法，以优化治疗效果、确保更平等的治疗可及性并尽量减少过度治疗。
