不同分子亞型Ⅰ、Ⅱ期乳腺癌新輔助化療的趨勢(shì)

不同分子亞型Ⅰ、Ⅱ期乳腺癌新輔助化療的趨勢(shì)摘要：乳腺癌是女性最常見的惡性腫瘤之一，分子分型的不同對(duì)于治療和預(yù)后有著重要意義。本文旨在探討乳腺癌不同分子亞型Ⅰ、Ⅱ期患者新輔助化療的趨勢(shì)。目前，HER2過表達(dá)、三陰性和激素受體陽性的乳腺癌是治療難點(diǎn)，因此針對(duì)不同亞型的治療策略是不同的。HER2過表達(dá)乳腺癌患者可以采用三重負(fù)荷的藥物治療，包括赫賽?。╰rastuzumab）、多西他賽（docetaxel）和氟尿嘧啶（5-FU）。對(duì)于激素受體陽性乳腺癌患者，內(nèi)分泌治療的有效性更高，新輔助內(nèi)分泌治療的意義在于優(yōu)化患者手術(shù)方式和治療安排。三陰性乳腺癌的治療往往包括鉑類藥物、多西他賽、毒蕈堿類藥物等多種方案的組合使用。本文綜述了乳腺癌不同分子亞型Ⅰ、Ⅱ期患者新輔助化療的最新進(jìn)展及應(yīng)用前景。

關(guān)鍵詞：乳腺癌；分子分型；新輔助化療；HER2過表達(dá)；激素受體陽性；三陰性

Introduction

Breastcancerisoneofthemostcommonmalignanttumorsinwomen,andthemolecularsubtypeshaveimportantsignificancefortreatmentandprognosis.ThepurposeofthispaperistoexplorethetrendofneoadjuvantchemotherapyfordifferentmolecularsubtypesofbreastcancerinstagesIandII.Currently,HER2-overexpressing,triple-negative,andhormonereceptor-positivebreastcanceraredifficulttotreat,sothetreatmentstrategiesfordifferentsubtypesaredifferent.HER2-overexpressingbreastcancerpatientscanbetreatedwithtripletdrugs,includingtrastuzumab,docetaxel,andfluorouracil.Forhormonereceptor-positivebreastcancerpatients,theeffectivenessofendocrinetherapyishigher,andthesignificanceofneoadjuvantendocrinetherapyistooptimizepatients'surgicalproceduresandtreatmentarrangements.Thetreatmentoftriple-negativebreastcanceroftenincludesacombinationofplatinumdrugs,docetaxel,amatoxin,andotherschemes.ThispaperreviewsthelatestprogressandapplicationprospectsofneoadjuvantchemotherapyfordifferentmolecularsubtypesofbreastcancerinstagesIandII.

HER2-overexpressingBreastCancer

HER2overexpressionisthemainfeatureofHER2-overexpressingbreastcancer,accountingforabout20%ofcases.TrastuzumabisaHER2monoclonalantibody,blockingtheHER2receptor,andinhibitingtheproliferationandmigrationofbreastcancercells.Docetaxelisamicrotubuleinhibitorthatcanpreventspindleformationandpreventcelldivision.FluorouracilisapyrimidineanaloguethatcaninterferewithDNAandRNAsynthesis.Thecombinationofthesethreedrugscanachieveasynergisticeffect,enhancetheefficacyofchemotherapy,andimprovethepathologicalcompleteresponserate(pCR)ofpatientswithHER2-overexpressingbreastcancer(Slamonetal.,2011).

HormoneReceptor-positiveBreastCancer

Hormonereceptor-positivebreastcanceraccountsforabout70%ofallbreastcancercases.Endocrinetherapyhasbecomethemainmethodoftreatinghormonereceptor-positivebreastcancer.Neoadjuvantendocrinetherapycanreducetumorsizeandimproveoperability,especiallyforhormonereceptor-positiveelderlypatientswhodonotmeetthesurgicalstandards.Thebenefitsofneoadjuvantendocrinetherapyincludedown-stagingthetumor,improvingsurgicalprocedures,andavoidingunnecessarymutilation(Thomasetal.,2018).Therearetwomaintypesofendocrinetherapy:selectiveestrogenreceptormodulators(SERMs)andaromataseinhibitors(s).TamoxifenisthemostcommonlyusedSERM,whichcanblocktheestrogenreceptorandinhibitthegrowthandproliferationofbreastcancercells.scaninhibitthesynthesisofestrogen,thusachievingthegoaloftreatinghormonereceptor-positivebreastcancer.

Triple-negativeBreastCancer

Triple-negativebreastcanceraccountsforabout15%ofallbreastcancercases.Thistypeofcancerlackstheexpressionofestrogen,progesterone,andHER2receptors,andisresistanttotraditionalendocrinetherapyandtargetedtherapy.Platinumdrugshavesignificantefficacyinthetreatmentoftriple-negativebreastcancer.ThemechanismofactionistoformacomplexwithDNA,interferewithDNAreplication,andkillcancercells.Neoadjuvantchemotherapyfortriple-negativebreastcanceroftenincludesacombinationofplatinumdrugsandtaxanedrugs.Studieshaveshownthatthepathologicalcompleteresponserateofneoadjuvantchemotherapyfortriple-negativebreastcancerishigherthanthatofothersubtypes,andpatientscanobtainthemaximumtherapeuticbenefits(Silveretal.,2010).

Conclusion

Neoadjuvantchemotherapyisanimportantpartofbreastcancertreatment.Fordifferentmolecularsubtypesofbreastcancer,newneoadjuvantchemotherapystrategieshavebeendeveloped,whichcaneffectivelyimprovethepCRrateandlong-termsurvivalrateofpatients.HER2-overexpressingbreastcancercanbetreatedwithtripletdrugstoachieveasynergisticeffect.Hormonereceptor-positivebreastcancercanbenefitfromneoadjuvantendocrinetherapy,whichcanreducetumorsizeandimproveoperabilitywhileavoidingunnecessarymutilation.Triple-negativebreastcancerisresistanttotraditionalendocrinetherapyandtargetedtherapy,andplatinumdrugshavesignificantefficacy.Inthefuture,withthedevelopmentoftargetedtherapy,neoadjuvantchemotherapyforbreastcancerwillhavemoreprecise,personalizedandeffectivetreatmentstrategies.

Keywords:breastcancer;molecularsubtype;neoadjuvantchemotherapy;HER2-overexpressing;hormonereceptor-positive;triple-negativeBreastcancerisacomplexdiseaseandisclassifiedintodifferentmolecularsubtypesbasedonthepresenceorabsenceofhormonereceptors(HR),humanepidermalgrowthfactorreceptor2(HER2),andothergeneticmarkers.Thethreemajorsubtypesarehormonereceptor-positive(HR+),HER2-overexpressing,andtriple-negativebreastcancer(TNBC).Eachmolecularsubtypehasdifferenttreatmentoptionsandprognosis.

Neoadjuvantchemotherapyisatypeoftherapythatisgivenbeforesurgerytoreducethesizeofthetumorandincreasethelikelihoodofsuccessfulsurgicalremoval.Thistreatmentstrategyhasbecomethestandardofcareforlocallyadvancedbreastcancerandisincreasinglybeingusedforearlierstagedisease.Neoadjuvantchemotherapyhasseveraladvantages,includingtheabilitytoevaluatetheresponsetotreatment,assessthetumor'sbiology,andpotentiallyeliminatemicrometastases.

Theselectionofneoadjuvantchemotherapyisbasedonthepatient'smolecularsubtype.ForHR+breastcancer,hormonetherapyisusuallythefirst-linetreatment,butincaseswherethetumorislargeorlocallyadvanced,neoadjuvantchemotherapymaybeused.HER2+breastcanceristreatedwithtargetedtherapyinadditiontochemotherapy,withtrastuzumabbeingthepreferredagent.ForTNBC,neoadjuvantchemotherapyisthemainstayoftreatmentsincethissubtypedoesnotrespondtohormonetherapyortargetedtherapy.

Platinumdrugs,suchascisplatinandcarboplatin,haveshownsignificantefficacyinthetreatmentofTNBC.ThesedrugsworkbydamagingtheDNAofcancercells,leadingtotheirdeath.However,notallTNBCpatientsrespondtoplatinumdrugs,andthereisaneedforbiomarkerstoidentifythosewhoarelikelytobenefit.

Inconclusion,neoadjuvantchemotherapyisanimportanttreatmentstrategyforbreastcancer.Withthedevelopmentoftargetedtherapy,neoadjuvantchemotherapyisexpectedtobecomemorepersonalizedandeffectiveinthefuture.ItisimportanttotailorthetreatmentapproachtothemolecularsubtypeofbreastcancerwhileavoidingunnecessarymutilationInadditiontoneoadjuvantchemotherapy,thereareseveralothertreatmentoptionsforbreastcancer,includingsurgery,radiationtherapy,andadjuvantsystemictherapy.Surgeryisusuallythefirst-linetreatmentforlocalizedbreastcancerandinvolvestheremovalofthetumorandsurroundingtissue.Radiationtherapyisoftenusedaftersurgerytokillanyremainingcancercellsandreducetheriskofrecurrence.Adjuvantsystemictherapy,whichincludeshormonetherapyandtargetedtherapy,isusedtokillanyremainingcancercellsthatmayhavespreadbeyondthebreast.

Hormonetherapyisusedforhormonereceptor-positivebreastcancer,whichaccountsforapproximatelytwo-thirdsofallbreastcancers.Hormonetherapyworksbyblockingtheeffectsofestrogenandcanbegivenbeforeoraftersurgery.Themostcommontypeofhormonetherapyistamoxifen,whichistakenorallyforfiveyears.Othertypesofhormonetherapyincludearomataseinhibitors,whichareusedinpostmenopausalwomen,andovariansuppression,whichisusedinpremenopausalwomen.

TargetedtherapyisusedforHER2-positivebreastcancer,whichaccountsforapproximately20%ofallbreastcancers.HER2isaproteinthatisoverexpressedinsomebreastcancercellsandpromotestheirgrowth.TargetedtherapyworksbytargetingHER2andslowingorstoppingthegrowthofcancercells.Themostcommontypeoftargetedtherapyistrastuzumab,whichisgivenintravenouslyforoneyear.

Inconclusion,breastcancerisacomplexdiseasethatrequiresamultidisciplinaryapproachtotreatment.Neoadjuvantchemotherapyisanimportanttreatmentstrategythatcanhelpshrinktumorsandimproveoutcomesforpatients.Withthedevelopmentoftargetedtherapyandpersonalizedmedicine,thefutureofbreastcancertreatmentlookspromising.However,itisimportanttocontinueresearchandworktowardsfindingnewandmoreeffectivetreatmentsforalltypesofbreastcancerBreastcanceristhemostcommoncanceramongwomenworldwide,anditsincidencehasbeenincreasingoverthepastfewdecades.Thediseaseishighlycomplex,anditsmanagementrequiresamultidisciplinaryapproach.Inrecentyears,neoadjuvanttherapyhasemergedasanimportanttreatmentstrategyforbreastcancer.Thisapproachinvolvesadministeringchemotherapyortargetedtherapybeforesurgerytoshrinkthesizeofthetumorandincreasetheefficacyofsurgery.

Neoadjuvantchemotherapyistypicallyusedforpatientswhohavelocallyadvancedbreastcancerortumorsthataretoolargetoberemovedsurgicallywithoutcausingsignificantcosmeticorfunctionaldamage.Insomecases,neoadjuvantchemotherapycanconverttumorstoasmallersize,allowingbreast-conservingsurgeryinsteadofmastectomy.Thisapproachhasshowntoimproveoutcomes,withstudiesreportingahigherrateofcompletetumorresponse,reducedtumorsize,andimprovedsurgicaloutcomes.

Targetedtherapyisaformofcancertreatmentthatinvolvestheuseofdrugsorothersubstancesthatspecificallytargetcancercells.Unlikechemotherapy,whichtargetsallrapidlydividingcellsinthebody,targetedtherapyisdesignedtodisruptspecificmoleculesorsignalingpathwaysthatareessentialforcancercellgrowthandsurvival.Targetedtherapyhasrevolutionizedbreastcancertreatment,andmanydrugshavebeendevelopedspecificallytotargetdifferentsubtypesofbreastcancer.

OnesuchexampleistheuseoftrastuzumabforHER2-positivebreastcancer.HER2isagrowth-promotingproteinthatisoverexpressedinapproximately20%ofbreastcancers.TrastuzumabisamonoclonalantibodythatbindstoHER2,preventingitssignalingandpromotingcancercelldeath.Theuseoftrastuzumabinneoadjuvanttherapyhasshowntoimproveoutcomesandincreasetherateofcompletetumorresponse.

Personalizedmedicineisanemergingapproachtocancertreatmentthatinvolvestailoringtreatmenttoindividualpatientsbasedontheiruniquemolecularprofile.Withadvancesingenomics,itisnowpossibletoidentifymutationsorothergeneticalterationsthatdrivecancergrowthandprogression.Thisinformationcanbeusedtoselectthemostappropriatetreatmentforeachpatient.Thisapproachhasshownpromisein