HER2阳性乳腺癌脑转移系统治疗选择研究进展

Advances in systemic treatment options for brain metastases in HER2-positive breast cancer

人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性乳腺癌患者易发生脑转移。血脑屏障/血肿瘤屏障导致药物递送效率低是脑转移系统治疗过程中面临的主要困境,故长期以来HER2阳性乳腺癌脑转移患者的治疗选择相对较少,预后较差。传统观点认为,大分子药物难以通过血脑屏障,但随着对血脑屏障/血肿瘤屏障特性了解的深入,这种观点逐步得到了改变,尤其是近年来多项临床研究证实了新型抗体偶联药物(antibody-drug conjugates,ADC)在脑转移人群中的疗效,这些发现为HER2阳性乳腺癌脑转移患者带来了更多治疗选择。本文综述了系统治疗药物的作用机制,并着重梳理了当前HER2阳性乳腺癌脑转移患者系统治疗的重要研究进展,以期为中国HER2阳性乳腺癌脑转移的临床治疗实践提供参考。

Patients with human epidermal growth factor receptor 2(HER2)-positive breast cancer are prone to develop brain metastases.Inefficient drug delivery due to the blood-brain barrier/blood-tumor barrier is a major dilemma in the systemic treatment of brain metastases.Therefore,patients with HER2-positive breast cancer brain metastasis usually have few treatment options and poor prognosis.In traditional opinions,it is difficult for macromolecule drugs to cross the blood-brain barrier,but with the in-depth understanding of the properties of the blood-brain barrier/blood-tumor barrier,this view has gradually changed,especially when several clinical studies have validated the efficacy of new antibodydrug conjugates(ADC)in patients with brain metastasis in the recent years.These findings have provided more treatment options for HER2-positive breast cancer patients with brain metastasis.This review introduces the mechanism of systemic treatment drugs and sorts out the current important advances in systemic treatment for HER2-positive breast cancer patients with brain metastases,hoping to provide some reference for the clinical practice of treatment for HER2-positive breast cancer brain metastases in China.