激素受体阳性早期乳腺癌治疗现状与挑战

在早期发现、有效治疗的情况下,早期乳腺癌是可治愈的,长期无病生存应是早期患者所追求的治疗目标.既往认为乳腺癌各亚型中激素受体(hormone receptor,HR)阳性早期乳腺癌预后最好,然而随着人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性乳...

Treatment landscape and challenges of managing the hormone receptor-positive early breast cancer

Early breast cancer can be cured if treated effectively upon diagnosis. Long-term disease-free survival should thus be the treatment goal for patients with early breast cancer. Hormone receptor (HR)-positive early breast cancer was believed to have the best prognosis among all the subtypes. However, as treatments for the human epidermal growth factor receptor 2 (HER2)- positive and triple-negative breast cancer advance, HR-positive breast cancer no longer exhibits an obvious prognostic advantage. At present, postoperative endocrine monotherapy with tamoxifen or aromatase inhibitors is the mainstay of adjuvant treatment for HR-positive early breast cancer. However, some patients are at a high risk of disease recurrence which would greatly affect their long-term survival. To improve the prognosis and quality of life for these patients, clinical research has been focusing on three main directions: ① Treatment escalation: patients at risk are recommended to escalate treatment by extending endocrine therapy or adding ovarian function suppression etc. Recent studies also explored the efficacy and safety of cyclin-dependent kinase 4 and 6 inhibitors as an option for treatment escalation in HR-positive early breast cancer. Accurate identification of high-risk patients suitable for treatment escalation is also a research hotspot where breast cancer index and STEPP analysis have already been recommended by authoritative guidelines to assist in the decision-making of treatment escalation. ② De-escalation or exemption of chemotherapy: to avoid excessive use of chemotherapy is a main trend in the area. Several international guidelines recommend using gene expression profiling tools such as MammaPrint ^® , Oncotype DX ^® and EndoPredict ^® to help predict the necessity of adjuvant chemotherapy. The clinical research and use of these tools are also increasing in China and may help bring more benefits to Chinese patients. ③ Preoperative endocrine therapy: although the beneficial effect of preoperative endocrine therapy remains to be further investigated, a number of studies have suggested that changes in certain biomarkers during preoperative endocrine therapy are closely related to patient prognosis and may play an important role in subsequent treatment decisions (e.g., exemption of chemotherapy, application of cyclin-dependent kinase 4 and 6 inhibitors). This review summarized and discussed the above mentioned treatment landscape and recent research progress of HR-positive breast cancer, to provide reference for clinicians.