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乳腺癌|盘点 2020｜马飞教授：乳腺癌治疗新进展( 七 )


此外，越来越多的药物从用于晚期解救治疗，到早期辅助治疗，再到新辅助治疗，随着各类临床试验和新的治疗理念不断涌现，其治疗模式也从单一的新辅助化疗，转变为当前基于不同分子亚型的新辅助化疗、新辅助抗HER2靶向治疗联合化疗、新辅助内分泌治疗等 。其优势在于可评估病理缓解程度，进行危险度分层，在辅助治疗中实现个体化治疗[61,62] 。新辅助治疗是值得探索和研究的方向，同时也需要更多的研究去寻找评价治疗疗效的指标和最佳的药物组合 。
在靶向治疗方面，ADC是抗肿瘤治疗的新兴药物，具有独特的作用机制，是极具潜力的治疗方式，T-DM1已经在乳腺癌治疗中显示出良好疗效，新开发的ADC药物DS-8201和SG都展现出这种抗体偶联新模式的可行性和有效性 。
在内分泌治疗中，耐药问题仍是治疗的困境和亟待解决的主要难点之一，CDK4/6抑制剂是内分泌治疗的最佳搭档，然而为原发或继发CDK4/6抑制剂耐药患者寻找新的治疗策略是至关重要的且未被满足的需求，PI3Kα抑制剂及AKT抑制剂或许可成为此类患者的选择 。免疫治疗药物阿替利珠单抗和帕博利珠单抗的阳性结果为TNBC患者的治疗带来了曙光，但优势人群的选择标准尚未成熟，缺乏能够精准预测疗效及预后的免疫生物标志物，最佳的药物配伍方案仍待探索 。
乳腺癌治疗药物在不断开发，越来越多的临床试验在陆续开展，期待有更多的阳性结果为乳腺癌患者带来获益，以精准医学为基础，指导后续治疗，为乳腺癌患者带来疗效及生活质量的双重改善！
参考文献：
[1]ALLEMANI C, MATSUDA T, DI CARLO V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37?513?025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391(10125):1023-1075.
[2]WANG X, WANG S S, HUANG H, et al. Effect of Capecitabine Maintenance Therapy Using Lower Dosage and Higher Frequency vs Observation on Disease-Free Survival Among Patients With Early-Stage Triple-Negative Breast Cancer Who Had Received Standard Treatment: The SYSUCC-001 Randomized Clinical Trial[J]. JAMA, 2020. [Epub ahead of print]
[3]KAUFMAN PA, AWADA A, TWELVES C, et al. Phase Ⅲ open-label randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer previously treated with an anthracycline and a taxane[J]. J Clin Oncol, 2015, 33(6):594-601.
[4]LIU M C, HILLMAN D W, FRITH A E, et al. Randomized phase III trial of eribulin (E) versus standard weekly paclitaxel (P) as first- or second-line therapy for locally recurrent or metastatic breast cancer (MBC)[J]. J Clin Oncol, 2020, 38(15_suppl):1016-1016.
[5]WU Y, WANG Q, ZHANG J, et al. Incidence of peripheral neuropathy associated with eribulin mesylate versus vinorelbine in patients with metastatic breast cancer: sub-group analysis of a randomized phase Ⅲ study[J]. Support Care Cancer, 2020, 28(8):3819-3829.
[6]SCHNEEWEISS A, M?BUS V, TESCH H, et al. 160O Survival analysis of the randomized phase Ⅲ GeparOcto trial comparing neoadjuvant chemotherapy (NACT) of iddEPC versus weekly paclitaxel, liposomal doxorubicin (plus carboplatin in triple-negative breast cancer, TNBC) (PM(Cb)) for patients (pts) with high-risk early breast cancer (BC)[J]. Ann Oncol, 2020, 31:S303-S304.
[7]XU B, SUN T, ZHANG Q, et al. Efficacy of utidelone plus capecitabine versus capecitabine for heavily pretreated, anthracycline- and taxane-refractory metastatic breast cancer: final analysis of overall survival in a phase 3 randomised controlled trial[J]. Ann Oncol, 2020, S0923-7534(20)43130-8.
[8]SLAMON D, EIERMANN W, ROBERT N, et al. Abstract S5-04: Ten year follow-up of BCIRG-006 comparing doxorubicin plus cyclophosphamide followed by docetaxel (ACT) with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab (ACTH) with docetaxel, carboplatin and trastuzumab (TCH) in HER2+ early breast cancer[J]. Cancer Res, 2016, 76(4 Supplement):S5-04-S05-04.

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