三阴性乳腺癌新辅助治疗现状

Current situation of neoadjuvant therapy for triple negative breast cancer

目的 三阴性乳腺癌高侵袭、高复发、高转移且预后差,对内分泌治疗、抗Her-2靶向治疗不敏感。本研究总结了近年来三阴性乳腺癌新辅助治疗进展。方法 应用PubMed、CNKI、万方等数据库,以“TNBC、新辅助治疗、病理完全缓解”等作为搜索关键词,检索近年的相关文献。结果 病理完全缓解被认为是新辅助治疗预后评判的重要标准之一。蒽环类联合紫杉类药物仍然是TNBC患者的首选新辅助化疗方案,铂类药物的应用使BRCA基因突变TNBC患者有了更优的新辅助化疗方案,但血液学、消化系统等相关不良反应不可忽视。免疫调定点抑制剂相关药物被证实在TNBC新辅助治疗上能提高pCR,改善长期生存预后,且因药物不良反应停药较铂类药物发生率更低。肿瘤微环境靶向药物、多聚ADP核糖聚合酶抑制剂、PI3K/AKT/mTOR通路抑制剂等相关药物在多药联合方面上的临床研究有积极治疗效果。结论 TNBC新辅助治疗中,化疗是基础,免疫治疗已有相关临床试验成果,肿瘤微环境靶向药物、多聚ADP核糖聚合酶抑制剂、PI3K/AKT/mTOR通路抑制剂具有很大研究前景。

Objective tasis and poor prognosis,and it has poor effect on endocrine therapy and anti-HER-2 targeted therapy.This study summarized the progress of neoadjuvant therapy for triple negative breast cancer in recent years.Methods in recent years with“TNBC,neoadjuvant therapy,pathological complete response”as search keywords.Results prognosis of neoadjuvant therapy.Anthracycline combined with paclitaxel is still the preferred neoadjuvant chemotherapy regimen for TNBC patients.Platinum-based drugs provide a better neoadjuvant chemotherapy regimen for TNBC patients with BRCA gene mutation,but hematological and digestive adverse reactions need to be paid attention to.Drugs related to immune check point inhibitors have been proved to enhance pCR and improve long-term survival prognosis in TNBC neoadjuvant therapy,and discontinuation due to adverse drug reactions has a lower incidence than platinum drugs.In addition,the tumor microenvironment targeting drugs,poly ADP ribose polymerase inhibitors,PI3K/AKT/mTOR pathway inhibitors and other related drugs have positive therapeutic effects in clinical studies on multi-drug combination.ConclusionIn the neoadjuvant therapy of TNBC,chemotherapy is the basis,and immunotherapy has achieved relevant clinical trial results.Tumor microenvironment targeting drugs,PARP inhibitors,and PI3K/AKT/mTOR pathway inhibitors have great research prospects.