自从抗HER2疗法出现以来,围绕小的辅助治疗的证据(T1mic,T1a,和T1b),node-negative,HER2阳性乳腺癌(HER2+BC)仍然有限。机构之间的实践差异很大,对全身治疗的额外益处知之甚少。包括细胞毒性化疗和HER2定向治疗。我们小组已着手对有关此主题的现有文献进行广泛的审查。
在这篇评论中,我们检查了HER2生物学,抗HER疗法,结果定义,和可用的前瞻性和回顾性数据,围绕辅助治疗在那些小,node-negative,HER2+BC。对于结果,我们主要探讨乳腺癌特异性生存率(BCSS),侵袭性无病生存期(iDFS),总生存率(OS)。我们还调查了不良事件的发生率,特别关注射血分数的有症状和无症状下降。
回顾性数据可能是未来治疗决策的主要驱动因素。鉴于我们所知道的,高危T1b和T1c亚组可从HER2指导联合治疗中获得可测量的额外获益,但目前尚不清楚这些获益是否超过与该联合治疗相关的已知风险.对于肿瘤≤0.5cm(T1mic和T1a),治疗仍存在很大争议,通过回顾性分析获得的证据有限,提示可能发生过度治疗.
Since the advent of anti-HER2 therapies, evidence surrounding adjuvant treatment of small (T1mic, T1a, and
T1b), node-negative, HER2-positive breast cancer (HER2+ BC) has remained limited. Practices vary widely between institutions with little known regarding the added benefit of systemic therapy, including cytotoxic chemotherapy and HER2-directed treatments. Our group has set out to perform an extensive review of available literature on this topic.
In this review, we examined HER2 biology, anti-HER therapies, outcome definitions, and available prospective and retrospective data surrounding the use of adjuvant therapy in those with small, node-negative, HER2+ BC. For outcomes, we primarily explored breast cancer-specific survival (BCSS), invasive disease-free survival (iDFS), and overall survival (OS). We also investigated the incidence of adverse events with a particular focus on symptomatic and asymptomatic declines in ejection fraction.
Retrospective data will likely be the main driver for future treatment decisions. Given what we know, high-risk
T1b and T1c subgroups derive measurable added benefit from HER2-guided combination therapies but it\'s not clear whether these benefits outweigh known risks associated with this combination therapy. For tumors ≤0.5 cm (T1mic and T1a), treatment remains highly controversial with limited evidence available through retrospective analysis that suggest over-treatment may be occurring.