在实际临床实践中选择 HER2 阳性乳腺癌辅助疗法:俄罗斯联邦医生偏好分析

E. Lubennikova, E. Artamonova
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摘要

曲妥珠单抗的辅助治疗为提高HER2阳性乳腺癌患者的无病生存率和总生存率做出了重大贡献。然而,在一些临床情况下,疾病复发的风险仍然会增加。根据病理形态学反应的程度,进行新辅助治疗后再进行新辅助治疗是现代的标准,这样可以治愈更多的患者。这要归功于特异性抗 HER 药物库的扩充,以及双抗 HER2 阻滞剂(曲妥珠单抗 + 培妥珠单抗)和细胞抑制药物抗体共轭物--曲妥珠单抗 emtansine 被引入临床实践。为了评估俄罗斯联邦的实际临床实践,开展了一项名为 "HER2 阳性乳腺癌治疗 "的调查研究。来自全国不同地区的 50 名专家参与了此次调查,他们直接参与为患者制定治疗方案,从而反映出主要化疗专家对 HER2 阳性乳腺癌治疗策略的偏好。本刊物反映了部分调查结果,专门讨论了 HER2 阳性乳腺癌辅助治疗和新辅助治疗后的选择。调查发现了一个明显的积极趋势,即倾向于先进行新辅助治疗,然后使用现代靶向药物(如百妥珠单抗和曲妥珠单抗)进行新辅助治疗后的治疗。调查结果显示,68%的RCB-II-III残留肿瘤患者接受了新辅助治疗后的曲妥珠单抗恩坦嗪,而在2021年,这一数字仅为24%。绝大多数未接受新辅助治疗但处于N2-3期的患者在辅助治疗中接受曲妥珠单抗+pertuzumab的双重抗HER2治疗。治疗的依从性很高,97%的患者完成了T-DM1的计划疗程,91.2%的患者完成了一年的抗HER2辅助治疗。这些数字明显高于登记研究的指标。在选择疗法时,疗效问题显得尤为重要。药物供应问题依然重要,但并非决定性因素。调查还揭示了一些乍看之下并不明显但却影响治疗结果的因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Choice of adjuvant therapy for HER2-positive breast cancer in real clinical practice: analysis of physician preferences in the Russian Federation
Adjuvant therapy with trastuzumab made a significant contribution to improving disease-free and overall survival rates in patients with HER2-positive breast cancer. However, in a number of clinical situations the risk of disease recurrence remains increased. Carrying out neoadjuvant treatment followed by post-neoadjuvant therapy, depending on the degree of pathomorphological response, is the modern standard, allowing to cure a significantly larger number of patients. This became possible thanks to the expansion of the arsenal of terget anti-Her drugs and the introduction into real clinical practice of double anti-HER2 blockade (trastuzumab + pertuzumab) and an antibody conjugate with a cytostatic drug – trastuzumab emtansine. To assess actual clinical practice in the Russian Federation, a survey study “Therapy of HER2-positive breast cancer” was conducted. The survey involved 50 specialists from different regions of the country who are directly involved in developing a treatment plan for patients, which allows them to reflect the preferences of leading chemotherapists regarding tactics for HER2-positive breast cancer. This publication reflects the results of part of the survey, devoted to the choice of adjuvant and post-neoadjuvant therapy for HER2-positive breast cancer. Identified a clear positive trend in favor of neoadjuvant treatment followed by post-neoadjuvant therapy using modern targeted drugs such as pertuzumab and trastuzumab emtansine. The survey results show that 68% of patients with RCB-II–III residual tumor receive post-neoadjuvant trastuzumab emtanzine, in 2021 this figure was only 24%. The absolute majority of patients who have not received neoadjuvant therapy, but have N2–3 stage, receive double anti-HER2 therapy with trastuzumab + pertuzumab in the adjuvant setting. High adherence to the therapy was noted, as 97% of patients complete the planned course of T-DM1, and 91.2% of patients complete a year of adjuvant anti-HER2 therapy. These figures are noticeably higher than the indicators of registration studies. Issues of effectiveness come to the fore in choosing therapy. Issues of drug availability remain relevant, but are not decisive. The survey also revealed factors that were not obvious at first glance and influenced treatment results.
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