新辅助策略开启了早期乳腺癌准个体化治疗的新时代

Neoadjuvant strategy usher in a new era of quasi-individualized treatment for early breast cancer

近年来,早期乳腺癌的治疗顺序发生了根本改变。一些临床试验表明,取代手术-辅助化疗模式,在手术前进行全身化疗(联合人类表皮生长因子受体2靶向治疗)具有明显获益。新辅助治疗可以使原发肿瘤和淋巴结降期,可以将不可手术转变为可手术,不可保乳变为可保乳,并可能避免腋窝淋巴结清扫。同时新辅助治疗还可以监测个体的药敏反应,以及基于残留病灶的更准确的预后评估,从而指导术后的强化辅助治疗。新辅助治疗的升阶及降阶治疗包括:获得病理完全缓解的患者可能避免进一步化疗或降阶局部区域治疗,而具有残留病灶的患者可以在术后接受强化全身治疗。因此,新辅助治疗不再是一种选择,而成为早期乳腺癌准个体化治疗的标准平台。

Treatment sequencing in early-stage breast cancer has significantly changed in recent years.Instead of surgery-adjuvant chemotherapy mode,several clinical trials showed benefits using administering systemic chemotherapy(and human epidermal growth factor receptor 2 targeted therapies)prior to surgery.Neoadjuvant therapy(NAT)could frequently downstage the primary tumor and lymph nodes,allowing conversion of the planned surgery form inoperable to operable one,from a mastectomy to a lumpectomy,and potentially allowing omission of axillary lymph node dissection.These benefits also include providing the opportunity to monitor the individual drug response and more accurate prognostic estimates based on the extent of residual cancer that can guide additional adjuvant treatment.This allows escalation or de-escalation of NAT:patients who achieved pathologic complete response could be spared further chemotherapy or de-escalation of locoregional therapies,while those with residual cancer could receive additional systemic therapy postoperatively.NAT is not an option anymore but a platform for personalized breast cancer therapy.