HER-2阳性乳腺癌新辅助治疗的热点问题与研究进展

Hot topics and research advances in neoadjuvant therapy for HER-2 positive breast cancer

摘要:

目前，人表皮生长因子2（HER-2）阳性乳腺癌因其独特的靶点以及其治疗药物已经成为研究乳腺癌治疗的重点和热点。针对已经发病的乳腺癌，早期治疗方面显得尤为重要，乳腺癌的治疗主要分为两大类：一类是局部治疗，包括早期的保乳手术、前哨淋巴结、区域淋巴结的放疗，第二类则为全身治疗，包括新辅助治疗和辅助治疗在内，虽然目前乳腺癌的主要治疗是手术治疗，但是有些患者在手术治疗前需要进行新辅助治疗，新辅助治疗的人群大都是乳腺癌Ⅲ期或者部分ⅡA、ⅡB期患者，这就突出了新辅助治疗的重要性，针对上述两点，HER-2阳性乳腺癌的新辅助治疗需要重点关注，现如今其中的4个热点问题仍需进一步探索：⑴ 乳腺癌在蒽环类药物的治疗，因其在乳腺癌新辅助治疗的基石地位和其对患者心脏毒性的副作用，不免使得研究者们引起争议，对于有基础疾病，尤其是心脏方面的患者，是否会加重病情，影响手术标准；⑵ 新辅助靶向治疗周期的选择，治疗周期的选择也同样重要，治疗时间短达不到患者手术的标准，但是治疗时间长容易使患者错过最佳手术时机，耽误患者病情，并且治疗时间延长，患者是否可以耐受，以及患者的心态问题，都影响手术的成功；⑶ 以曲妥珠单抗为基础的最佳配偶靶向药物的选择，单靶治疗在HER-2阳性乳腺癌研究的初期被专家们极力推荐，但随着更多药物在中国获批，双靶药物治疗HER-2阳性乳腺癌成为热点中的热点；⑷ HER-2阳性乳腺癌新辅助治疗后双靶治疗的选择，新辅助治疗后如何选择双靶治疗，需要根据新辅助治疗时患者对于药物的敏感性以及是否达到患者所需要的病理学完全缓解（pCR）率，下面就这4个热点问题分别进行展开讨论，以为临床工作提供新的思路。

Abstract:

Currently, human epidermal growth factor receptor 2 (HER-2) positive breast cancer has become a focus and hotspot in the research of breast cancer treatment due to its unique target and therapeutic drugs. Early treatment is particularly important for diagnosed breast cancer. Breast cancer treatment is mainly divided into two categories: local treatment, including early breast-conserving surgery, sentinel lymph nodes, and regional lymph node radiotherapy, and systemic treatment, including neoadjuvant therapy and adjuvant therapy. Although surgical treatment is currently the main treatment for breast cancer, some patients require neoadjuvant therapy before surgery. The population receiving neoadjuvant therapy mostly consists of stage Ⅲ breast cancer or some stage IIA and IIB patients, highlighting the importance of neoadjuvant therapy. In light of these two points, neoadjuvant therapy for HER-2 positive breast cancer needs special attention. Currently, four hot topics in this area require further exploration: 1. The treatment of breast cancer with anthracycline drugs, which has sparked controversy among researchers due to its cornerstone role in neoadjuvant therapy for breast cancer and its cardiotoxic side effects. Whether it exacerbates the condition and affects surgical standards for patients with underlying diseases, especially heart-related issues, is a concern. 2. The selection of the neoadjuvant targeted therapy cycle. The choice of treatment duration is equally important. A short treatment period may not meet the surgical standards, while a long treatment duration may cause patients to miss the optimal surgical timing, delaying their condition. The patient's tolerance to extended treatment and their psychological state also impact the success of the surgery. 3. The selection of the optimal combination targeted therapy based on trastuzumab. Single-target therapy was strongly recommended by experts in the early stages of HER-2 positive breast cancer research. However, with the approval of more drugs in China, the use of dual-target drugs for treating HER-2 positive breast cancer has become a hot topic within the field. 4. The choice of dual-target therapy after neoadjuvant therapy for HER-2 positive breast cancer. The selection of dual-target therapy after neoadjuvant therapy depends on the patient's sensitivity to the drugs during neoadjuvant treatment and whether they achieve the patient's desired pathological complete response rate (pCR). The following discussion will delve into these four hot topics, providing new insights for clinical practice.