晚期乳腺癌内分泌分层治疗进展

Update on endocrine stratified therapy for advanced breast cancer

晚期激素受体阳性乳腺癌的内分泌治疗已进入靶向时代。周期蛋白依赖性激酶4/6(cyclin-dependent kinase 4/6,CDK4/6)抑制剂、组蛋白去乙酰化酶(histone deacetylase,HDAC)抑制剂和磷脂酰肌醇3-激酶(phosphatidylinositide 3-kinase,PI3K)/蛋白激酶B (protein kinase B,PKB)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)抑制剂等靶向药物的应用已改变了晚期激素受体阳性乳腺癌内分泌治疗的临床实践,显著延长了患者的生存期。面对诸多新型药物,如何制定最优化和个体化的治疗方案仍是临床关注的焦点。2022年新版中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)乳腺癌指南充分考量循证医学证据等级、治疗药物可及性及最新研究进展,并针对既往用药情况提出分层策略,对晚期激素受体阳性乳腺癌的内分泌治疗方案予以相应推荐,为乳腺癌临床实践提供了指导依据。

Endocrine therapy for hormone receptor positive advanced breast cancer has entered the era of targeted therapy.The targeted drugs such as cyclin-dependent kinase 4/6(CDK 4/6)inhibitors,histone deacetylase(HDAC)inhibitors,and phosphatidylinositide 3-kinase(PI3K)/protein kinase B(PKB)/mammalian target of rapamycin(mTOR)inhibitors have changed the clinical practice in the endocrine ther-apy for hormone receptor positive advanced breast cancer,and significantly prolonged the overall survival of patients.In the face of various targeted therapeutic drugs,how to develop the optimal and individualized treatment plan is still the focus of clinical attention.The updated 2022 version of Chinese Society of Clinical Oncology(CSCO)breast cancer guidelines fully take into account the level of evidence-based medicine,changes in drug accessibility,and latest research progress,and propose stratified strategies based on the previous history of en-docrine treatment,and recommend endocrine treatment options for hormone receptor positive advanced breast cancer,which provides a guiding basis for the clinical practice of breast cancer.