三阴乳腺癌的最新治疗进展

Latest Development in Treatment of Triple-Negative Breast Cancer

近年在发达国家,乳腺癌的死亡率显著降低,但几乎所有的生存受益均来自于激素受体或HER-2受体阳性的乳腺癌患者。三阴乳腺癌是指雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(HER 2)均为阴性的乳腺癌,约占所有乳腺癌的15%,虽对化疗敏感但较激素受体阳性及HER-2受体阴性的乳腺癌预后差。它是一种高度异质性的肿瘤且不能从内分泌或曲妥珠单抗治疗中获益,故化疗为其唯一的全身治疗手段。最新的临床研究结果显示,在紫杉类/蒽环类为基础的传统化疗方案的基础上加用希罗达能显著改善三阴乳腺癌患者的无复发生存期(RFS)和总生存期(OS)。三阴乳腺癌与BRCA1突变之间有着一定的联系,尽管其机制未明但可以此为突破点作为治疗选择。多聚ADP核糖聚合酶抑制剂BSI-201和olaparib、抗血管生成因子及表皮生长因子抑制剂在三阴乳腺癌的治疗中均显示了较高的有效率。关注这些最新的治疗进展将有助于发现新的治疗途径及寻找出标准的治疗三阴乳腺癌的化疗方案。

There has been a remarkable decrease in mortality caused by breast cancer in developed countries over the past fewyears. Nearly all benefits are found in patients with hormone receptor and/or human epidermal growth factor receptor （HER）-2-positive breast cancer. Triple-negative breast cancer denotes tumors that do not express the estrogen receptor, progesterone receptor, and HER-2 genes that accounts for approximately 15% of breast cancer. This cancer is more chemosensitive but has a worse prognosis compared with the HR-positive/HER-2-negative phenotype. Triple-negative breast cancer is a highly heterogeneous disease but is not treatable by endocrine or trastuzumab therapy. Therefore, the standard chemotherapy, such as the combination of anthracycline and taxane, is the only feasible method of systemic therapy. Latest results of clinical research have demonstrated that taxane/anthracycline-based conventional chemotherapeutic regimens plus Xeloda can significantly enhance the recurrence-free survival and overall survival of triple-negative breast cancer patients. Recent studies have suggested that there is a definite relationship between BRCA1 mutations and triple-negative disease, although the mechanism of the relationship remains unclear. Recently, poly（ADP-ribosyl） polymerase inhibitors BSI-201 and olaparib were found to be highly effective for triple-negative breast cancer. Antiangiogenic agents, such as bevacizumab, have demonstrated efficacy in the subtypes of cancer. Epidermal growth factor receptor inhibitors also exhibit a role in treating triple-negative breast cancer. Given the latest progress of the therapy, the development of effective novel approaches and standard regimens of chemotherapy for triple-negative breast cancer is essential.