三阴性乳腺癌精准治疗研究的新进展与未来展望

New research advances and future prospect in precision treatment of triple-negative breast cancer

世界卫生组织国际癌症研究机构最新发布的数据显示,乳腺癌现已取代肺癌成为全球发病率最高的恶性肿瘤。三阴性乳腺癌(triple-negative breast cancer,TNBC)是雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)表达均为阴性的乳腺癌,与其他分子分型的乳腺癌相比,TNBC具有易复发转移、整体预后差等特点。TNBC对内分泌治疗及抗HER2治疗不敏感,化疗是其主要的系统治疗手段。随着基因组学、转录组学、代谢组学、蛋白组学、微生物组学的蓬勃发展及对TNBC分子分型的深入研究,针对不同靶点的靶向治疗药物和针对免疫检查点的免疫治疗药物的出现,如多聚腺苷二磷酸核糖聚合酶[poly(ADP-ribose) polymerase,PARP]抑制剂、人滋养细胞表面抗原2(trophoblast cell-surface antigen 2,TROP-2)抗体药物偶联物、pembrolizumab、atezolizumab、durvalumab等,已为TNBC的治疗提供新的手段,正在改变TNBC的临床实践。“精准治疗”“分类而治”是未来发展的方向。本文以TNBC的分子分型为基础,对其靶向治疗和免疫治疗研究的新进展进行归纳总结,以期为今后TNBC精准治疗策略提供参考。

According to the latest data released by the Cancer Research Institute of the World Health Organization, breast cancer has replaced lung cancer as the malignant tumor with the highest incidence rate in the world. Triple-negative breast cancer(TNBC)is defined by a lack of estrogen receptor(ER), progesterone receptor(PR), and human epidermal growth factor receptor 2(HER2).Compared with other types of breast cancer, TNBC bears the characteristics of high metastasis rate, strong invasiveness and poor prognosis. TNBC is not sensitive to endocrine therapy and anti-HER2 therapy, and chemotherapy is its main systemic treatment.With the vigorous development of genomics, transcriptomics, metabolomics, proteomics, microbiomics technologies and the indepth study of TNBC molecular subtyping, targeted therapy and immunotherapy drugs, including poly(ADP-ribose) polymerase(PARP) inhibitors, trophoblast cell-surface antigen 2(TROP-2) antibody-drug conjugate, pembrolizumab, atezolizumab, durvalumab,etc., have provided new therapeutic methods, which are changing the clinical practice and treatment pattern of TNBC. It is believed accurate therapy will become a new direction of development in the future. Based on the molecular subtypes of TNBC, here we summarized the research advances in targeted therapy and immunotherapy of TNBC, in order to provide reference for the precise treatment strategy of TNBC in the future.