Adjuvant application of trastuzumab in HER2 positive breast cancer and impact on time to relapse

Q4 Medicine
Nikolina Dukić, Z. Gojković, Jelena Vladičić-Mašić, S. Mašić, Nenad Lalović, S. Popovic
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引用次数: 1

Abstract

Received 2018-11-12 Received in revised form 2019-05-22 Accepted 2019-05-29 INTRODUCTION Breast cancer is the most common malignant disease in women (1). It makes up about 26.5% of all newly discovered malignancies in the European female population and is responsible for 17.5% of the deaths. In males, this type of cancer is rare (one man per 100 women) (2). The frequency of the disease differs in various parts of the world. It is rarely seen before the age of 30, it rises with age and reaches its maximum around the age of 50 (3). The incidence of breast cancer in the world increases by 1-2% per year, and it is estimated that in the first decade of the third millennium, almost one million of women will suffer from breast cancer (4). However, in spite of the increasing possibilities of treatment, survival depends primarily on the extent and stage of the disease at the time of detection. In the early stage of the disease in which the largest number of patients is detected, healing is quite possible. Still, 24-30% of patients with lymph node negative and 50-60% with lymph node positive breast cancer will develop relapse. At the moment of diagnosis metastatic disease is present in 6-10% of patients (5). Treatment of breast cancer is multidisciplinary. Combination of surgical treatment, radiation and systemic therapeutic treatment ensure good results in patient survival. The type and order of particular treatments must be planned multidisciplinary by surgeons-oncologists, radiotherapists and internists-oncologists (6). Clinical features of tumor such as size, the existence of tumor cells in the armpit lymph nodes, and distant metastases are considered essential in determining prognosis and choices of treatment. Prognostic factors, derived from breast tissue after biopsy or surgery, have significance in measuring tumor aggressiveness and general disease prognosis. The standard prognostic parameters are patient (menopausal status, age) and tumor related (tumor size, histological type, axillary lymphatic status, tumor gradient, ER, PR and HER2 status). Some of them (ER, PR and HER2 status) have a predictive value because the best therapeutic modality is chosen based on these. According to St. Gallen Consensus and ESMO recommendations from year 2013 breast cancers fall into different types according to histopathological findings and results of predictive and prognostic tests. Based on this, specific therapeutic approach is recommended. When luminal A type patient receive only endocrine therapy, and chemotherapy is considered only in cases of high risk tumor (with four or more positive lymph nodes, tumor size T3 or tumor grade 3). When luminal B-like type (HER2 negative) patient is treated using chemotherapy and endocrine therapy. When luminal B-like (HER2 positive) patient is treated using chemotherapy, anti-HER2 and endocrine therapy. In case of non-luminal (HER2 positive) breast cancer type chemoand anti-HER2 therapy is recommended. In patients with basal-like (triple-negative) cancer application of chemotherapy is indicated (7).
曲妥珠单抗在HER2阳性乳腺癌中的辅助应用及对复发时间的影响
乳腺癌是女性中最常见的恶性疾病(1),约占欧洲女性新发现恶性肿瘤的26.5%,占死亡人数的17.5%。在男性中,这种类型的癌症是罕见的(每100名女性中有1名男性)(2)。这种疾病在世界各地的发病率不同。很少看到在30岁之前,它随着年龄的上升,达到最大的50岁(3),乳腺癌的发病率在世界上每年增加1 - 2%,据估计,在第三年的第一个十年,近一百万的女性患乳腺癌(4)。然而,尽管治疗的可能性增加,生存主要取决于疾病的程度和阶段的检测。在发现患者最多的疾病早期,治愈是很有可能的。然而,24-30%的淋巴结阴性和50-60%的淋巴结阳性乳腺癌患者会复发。在诊断时,6-10%的患者存在转移性疾病(5)。乳腺癌的治疗是多学科的。手术治疗、放射治疗和全身治疗相结合,保证了患者良好的生存效果。特定治疗的类型和顺序必须由外科肿瘤学家、放射治疗师和内科肿瘤学家共同规划(6)。肿瘤的临床特征,如大小、腋窝淋巴结中肿瘤细胞的存在以及远处转移被认为是决定预后和治疗选择的必要因素。来自活检或手术后乳腺组织的预后因素在衡量肿瘤侵袭性和一般疾病预后方面具有重要意义。标准预后参数为患者(绝经状态、年龄)和肿瘤相关(肿瘤大小、组织学类型、腋窝淋巴状态、肿瘤梯度、ER、PR和HER2状态)。其中一些指标(ER, PR和HER2状态)具有预测价值,因为根据这些指标选择最佳治疗方式。根据圣加仑共识和ESMO 2013年的建议,乳腺癌根据组织病理学发现和预测和预后测试结果分为不同类型。在此基础上,建议采取特定的治疗方法。当管腔A型患者仅接受内分泌治疗,仅在高危肿瘤(四个及以上淋巴结阳性,肿瘤大小为T3或肿瘤分级为3)时才考虑化疗。当管腔b样(HER2阴性)患者同时接受化疗和内分泌治疗时。当腔内b样(HER2阳性)患者接受化疗、抗HER2和内分泌治疗时。对于非腔型(HER2阳性)乳腺癌,推荐化疗和抗HER2治疗。基底样(三阴性)癌患者应应用化疗(7)。
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来源期刊
Archive of Oncology
Archive of Oncology Medicine-Oncology
CiteScore
0.60
自引率
0.00%
发文量
5
审稿时长
12 weeks
期刊介绍: Archive of Oncology is an international oncology journal that publishes original research, editorials, review articles, case (clinical) reports, and news from oncology (medical, surgical, radiation), experimental oncology, cancer epidemiology, and prevention. Letters are also welcomed. Archive of Oncology is covered by Biomedicina Vojvodina, Biomedicina Serbica, Biomedicina Oncologica, EMBASE/Excerpta Medica, ExtraMED and SCOPUS.
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