Toi Masakazu
Cancer and Infectious Disease Center, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Kyoto University, Kyoto, Japan.
Transl Breast Cancer Res. 2025 Jun 18;6:23. doi: 10.21037/tbcr-25-2. eCollection 2025.
Antibody-drug conjugates (ADCs) have become the standard of care for metastatic advanced breast cancers, regardless of tumour subtype. Optimal positioning and treatment sequences are being studied, and many new therapies and combinations are also under development. Research into the application of ADC to early breast cancer is spreading. More than 10 clinical trials are being conducted regarding escalation and de-escalation of systemic treatment. In addition, in the sequence of neoadjuvant and adjuvant therapy, multiple key issues are investigated, such as effective sequences of treatments among ADC, cytotoxic chemotherapy, immunotherapy, and anti-human epidermal growth factor receptor 2 antibody therapy to improve treatment response, prognosis and quality of life (QOL). The postoperative activity of ADC with topoisomerase inhibitors for residual diseases is also being studied in post-neoadjuvant therapy settings. At the same time, many studies have focused on the appropriate timing of surgical therapy and response-guided approach. On the other hand, ADCs can cause serious side effects, although these are infrequent. Therefore, careful management is necessary during both pre-operative and post-operative adjuvant therapy. It is also crucial to focus on developing prognostic and predictive biomarkers to assess efficacy, alongside monitoring markers through translational research and image analysis. This review summarizes the development trends in both neoadjuvant and adjuvant settings, as well as recent data on ADCs for primary breast cancer, while addressing unresolved clinical questions. It discusses the escalation and optimization of treatment for primary breast cancer using ADCs, along with the relevant challenges and perspectives.
抗体药物偶联物（ADCs）已成为转移性晚期乳腺癌的标准治疗方案，无论肿瘤亚型如何。目前正在研究最佳的治疗定位和治疗顺序，许多新的疗法和联合治疗方案也在研发中。ADCs在早期乳腺癌中的应用研究正在不断拓展。关于全身治疗的剂量递增和递减，正在进行10多项临床试验。此外，在新辅助治疗和辅助治疗的序列中，还研究了多个关键问题，例如在ADCs、细胞毒性化疗、免疫治疗和抗人表皮生长因子受体2抗体治疗之间有效的治疗顺序，以提高治疗反应、改善预后和生活质量（QOL）。在新辅助治疗后的情况下，也正在研究ADCs与拓扑异构酶抑制剂联合用于残留疾病的术后活性。与此同时，许多研究集中在手术治疗的合适时机和反应引导方法上。另一方面，ADCs虽然很少见，但可能会引起严重的副作用。因此，在术前和术后辅助治疗期间都需要仔细管理。通过转化研究和图像分析来开发评估疗效的预后和预测生物标志物，同时监测标志物也至关重要。本综述总结了新辅助治疗和辅助治疗中的发展趋势，以及原发性乳腺癌ADCs的最新数据，同时解决未解决的临床问题。它讨论了使用ADCs治疗原发性乳腺癌的剂量递增和优化，以及相关的挑战和前景。
