乳腺癌新辅助内分泌治疗临床实践

　　对于激素受体阳性早期乳腺癌，虽然LNABC、IMPACT、PROACT研究已经证实术前新辅助内分泌治疗是一种能够降低肿瘤分期并且促进保乳手术的有效治疗方式，但是在临床实践中仅被用于少数不适合手术的绝经后女性，可能的原因包括习惯采用化疗以及内分泌治疗时间较长。

　　2021年9月9日，《美国医学会杂志》肿瘤学分册在线发表哈佛大学达纳法伯癌症研究所、布莱根医院和波士顿妇女医院、纽约纪念医院斯隆凯特林癌症中心、洛杉矶西达赛奈医疗中心的综述，对激素受体阳性HER2阴性乳腺癌术前新辅助内分泌治疗的临床实践进行了总结。

　　该综述利用2000年以来进行的研究数据，为读者提供了激素受体阳性HER2阴性乳腺癌术前新辅助内分泌治疗临床应用的深入回顾，包括：患者选择标准、方案选择、治疗持续时间、影像学缓解评估、治疗后病理学评估和手术考虑因素。

　　存在争议的领域包括：基因表达检测的患者选择、绝经前女性的治疗、新辅助内分泌治疗后的腋窝手术管理，以及术后全身辅助治疗的决策，包括化疗的应用。

　　该综述表明新辅助内分泌治疗是相当一部分被诊断为激素受体阳性乳腺癌绝经后女性的最佳治疗方式。激素受体阳性乳腺癌的治疗格局正在不断发展，随着层出不穷的新药和日益普及的基因表达分析，治疗选择被不断重新定义。因此，新辅助内分泌治疗的临床应用可能增加，该综述总结的实际考虑因素将更加重要。

JAMA Oncol. 2021 Sep 9. Online ahead of print.

Neoadjuvant Endocrine Therapy in Clinical Practice: A Review.

Sella T, Weiss A, Mittendorf EA, King TA, Pilewskie M, Giuliano AE, Metzger-Filho O.

Dana-Farber Cancer Institute, Boston, Massachusetts; Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York, New York; Cedars-Sinai Health System, Los Angeles, California.

This review summarizes clinical aspects related to the application of neoadjuvant endocrine therapy in the treatment of hormone receptor-positive/ERBB2-negative breast cancer.

IMPORTANCE: In clinical practice, neoadjuvant endocrine therapy (NET) is rarely used despite being an effective treatment modality able to downstage tumors and facilitate breast-conserving surgery.

OBSERVATIONS: Using data from studies conducted since 2000, we provide readers with a critical in-depth review on clinical aspects related to the application of NET in the treatment of hormone receptor (HR)-positive/ERBB2 (formerly HER2)-negative breast cancer. This includes an overview of patient-selection criteria, regimen choice, treatment duration, evaluation of response by imaging, interpretation of pathology after treatment, and surgical considerations. Areas of controversy include the use of gene-expression tests for patient selection, treatment of premenopausal women, surgical management of the axilla after NET, and adjuvant systemic therapy decision-making, including the use of chemotherapy.

CONCLUSIONS AND RELEVANCE: NET is an optimal treatment modality for a considerable proportion of postmenopausal women diagnosed with HR-positive tumors. The treatment landscape for HR-positive breast cancer is evolving, with novel agents and the growing use of gene expression profiling to define treatment selection. As such, it is likely that NET use will increase and the practical considerations outlined here will become more important.

PMID: 34499101

DOI: 10.1001/jamaoncol.2021.2132