乳腺癌新辅助治疗后受体状态:意义和启示

IF 3.5 4区 医学 Q3 CELL BIOLOGY Pathobiology Pub Date : 2022-05-30 DOI:10.1159/000521880
A. Shaaban, E. Provenzano
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引用次数: 10

摘要

新辅助化疗(NACT)已成为早期乳腺癌的常规治疗方法。据报道,NACT后雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2 (HER2)的变化,不同系列的结果差异很大。在更大的系列中,ER状态的变化确定在5-23%,而PR状态的变化更频繁(14.5-67%)。HER2状态变化的频率较低,丢失比获得更常见,与原位杂交和HER2靶向治疗相比,免疫组织化学观察到更高的变化率。三阴性是合并ER的最稳定的分子亚型,her2阳性癌症表现出最高的变化率。与NACT相比,新辅助内分泌治疗的使用较少,虽然ER的丢失很少见,但PR状态的改变可发生在高达40%的病例中。关于受体状态改变对生存结果影响的已发表数据相对较少。在nact后肿瘤变成ER或HER2阳性的患者,可以开始内分泌或抗HER2治疗,尽管缺乏临床试验的证据。目前大多数指南不建议常规复检;但是,在某些情况下应该考虑到这一点。
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Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications
Neoadjuvant chemotherapy (NACT) is now established in routine management of early breast cancer. Alterations in oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) following NACT are reported, with wide variation in results across series. In larger series, changes in ER status are identified in 5–23%, whilst changes in PR status are more frequent (14.5–67%). HER2 status changes less frequently with loss being more common than gain, and higher rates of change with immunohistochemistry are observed compared to in situ hybridization and following HER2-targeted therapy compared with chemotherapy alone. Triple negative is the most stable molecular subtype with combined ER, and HER2-positive cancers show the highest rate of change. Neoadjuvant endocrine therapy is used less commonly than NACT, and whilst loss of ER is rare, changes in PR status can occur in up to 40% of cases. There is relatively little published data on the impact of change in receptor status on survival outcomes. In patients whose tumours become ER or HER2 positive post-NACT, endocrine or anti-HER2 therapy can be initiated, although evidence from clinical trials is lacking. Most guidelines do not currently recommend routine retesting; however it should be considered in some circumstances.
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来源期刊
Pathobiology
Pathobiology 医学-病理学
CiteScore
8.50
自引率
0.00%
发文量
47
审稿时长
>12 weeks
期刊介绍: ''Pathobiology'' offers a valuable platform for the publication of high-quality original research into the mechanisms underlying human disease. Aiming to serve as a bridge between basic biomedical research and clinical medicine, the journal welcomes articles from scientific areas such as pathology, oncology, anatomy, virology, internal medicine, surgery, cell and molecular biology, and immunology. Published bimonthly, ''Pathobiology'' features original research papers and reviews on translational research. The journal offers the possibility to publish proceedings of meetings dedicated to one particular topic.
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