Trastuzumab for patients with HER2 positive breast cancer: Delivery, duration and combination therapies
Trastuzumab for patients with HER2 positive breast cancer: Delivery, duration and combination therapies
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DOI：
10.1016/j.breast.2013.07.029
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发表时间：
2013-08-01
期刊：
影响因子：
3.9
通讯作者：
Piccart-Gebhart, Martine
中科院分区：
文献类型：
--
作者：
Pinto, Ana Catarina;Ades, Felipe;Piccart-Gebhart, Martine
除了内分泌治疗外，没有其他乳腺癌患者的全身治疗能达到曲妥珠单抗如此大的有益效果。这种靶向药物（单克隆抗体）与辅助化疗联合或序贯给药时，HER-2阳性乳腺癌女性的无病生存期（DFS）和总生存期（OS）均显著改善。这一点已在最近的随机对照试验（RCT）的科克伦荟萃分析中得到证实，包括6项辅助研究和2项新辅助研究（NSABP B-31、NCCTG N9831、BCIRG 006、HERA、FinHer、PACS-04、Buzdar和NOAH），数据收集截止到2010年2月。总体而言，死亡率降低了三分之一，复发风险降低了40%。对心功能不全的担忧正在下降，报告表明其在大多数情况下是可逆的，但仍然缺乏真正的长期心脏评估。因此，曲妥珠单抗的获益可能受到心脏毒性的挑战，在低风险患者中[T1 a，B淋巴结阴性（NO）肿瘤]或心血管风险增加的患者（老年女性和既往有严重心脏病/左心室射血分数[LVEF，
With the exception of endocrine therapy, no other systemic treatment of patients with breast cancer has reached such a magnitude of beneficial effect as trastuzumab. This targeted agent (monoclonal antibody) is associated with a significant improvement in both disease-free (DFS) and overall survival (OS) in women with HER-2 positive breast cancer when given in combination with or in sequence to adjuvant chemotherapy. This has been confirmed in a recent Cochrane meta-analysis of randomized controlled trials (RCTs), including 6 adjuvant and 2 neoadjuvant studies (NSABP B-31, NCCTG N9831, BCIRG 006, HERA, FinHer, PACS-04, Buzdar and NOAH), with data collection until February 2010. Overall, mortality is reduced by one-third and the risk of relapse by 40%.Concerns regarding cardiac dysfunction are declining, with reports indicating its reversibility in most instances, however truly long term cardiac evaluation is still lacking.Hence, the benefit of trastuzumab could be challenged by cardiac toxicity, in lower-risk patients [T1a,b node-negative (NO) tumors] or those with increased cardiovascular risk (older women and patients with previous significant heart disease/suboptimal left ventricular ejection fraction [LVEF (