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中华乳腺病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 294 -300. doi: 10.3877/cma.j.issn.1674-0807.2023.05.007

综述

Luminal A型乳腺癌的内分泌治疗与化疗
王雪菲, 海琳悦, 李立方, 肖春花()   
  1. 天津医科大学肿瘤医院国家肿瘤临床医学研究中心/天津市"肿瘤防治"重点实验室/天津市恶性肿瘤临床医学研究中心
  • 收稿日期:2021-06-23 出版日期:2023-10-01
  • 通信作者: 肖春花

Endocrine therapy and chemotherapy for luminal A breast cancer

Xuefei Wang, Linyue Hai, Lifang Li   

  • Received:2021-06-23 Published:2023-10-01
引用本文:

王雪菲, 海琳悦, 李立方, 肖春花. Luminal A型乳腺癌的内分泌治疗与化疗[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 294-300.

Xuefei Wang, Linyue Hai, Lifang Li. Endocrine therapy and chemotherapy for luminal A breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(05): 294-300.

Luminal A型乳腺癌是恶性程度相对较低、预后相对良好的分型,其治疗方式和获益程度成为临床医师关注的重点问题。系统性辅助治疗是目前应用广泛的癌症治疗手段,能够提高进行根治性手术的机会和改善远期预后。针对Luminal A型乳腺癌,系统性辅助治疗的方案正在逐渐完善,临床应用最多且最有效的是内分泌治疗,其次是细胞毒化疗。本文主要对Luminal A型乳腺癌的内分泌治疗以及细胞毒化疗的研究进展、临床指南和现存问题进行了总结,期望能够为解决辅助治疗中的耐药及过度治疗问题提供一些新的研究思路,在分子生物学水平上寻找到改进治疗方案的方式,为Luminal A型的乳腺癌患者提供低成本、高收益的治疗选择。

表1 早期Luminal A型乳腺癌(新)辅助治疗推荐方案
表2 Luminal A型转移性乳腺癌(新)辅助治疗推荐方案
图1 Luminal A型乳腺癌细胞化疗耐药的部分机制注:AKT1为丝氨酸/苏氨酸蛋白激酶1;PI3K为磷脂酰肌醇3-激酶;RTK为受体酪氨酸激酶;COX5A为细胞色素c氧化酶5A;FOXA1为叉头框蛋白A1;LYPD3为Ly6/PLAUR结构域的蛋白质3;AGR2为前梯度蛋白2;ER为雌激素受体;PTEN为第10号染色体同源丢失性磷酸酶张力蛋白基因
[1]
Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023 [J]. CA Cancer J Clin, 2023, 73(1): 17-48.
[2]
Lumachi F, Brunello A, Maruzzo M, et al. Treatment of estrogen receptor-positive breast cancer [J]. Curr Med Chem, 2013, 20(5): 596-604.
[3]
Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study [J]. JAMA, 2006, 295(21): 2492-2502.
[4]
Boland MR, Ryan ÉJ, Nugent T, et al. Impact of progesterone receptor status on response to neoadjuvant chemotherapy in estrogen receptor-positive breast cancer patients [J]. J Surg Oncol, 2020, 122(5): 861-868.
[5]
Kubo M. Adjuvant endocrine treatment for estrogen receptor (ER)-positive/HER2-negative breast cancer [J]. Chin Clin Oncol, 2020, 9(3): 33.
[6]
Höller A, Nguyen-Sträuli BD, Frauchiger-Heuer H, et al. "Diagnostic and prognostic biomarkers of luminal breast cancer: where are we now?" [J]. Breast Cancer (Dove Med Press), 2023, 15: 525-540.
[7]
Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the primary therapy of early breast cancer 2017 [J]. Ann Oncol, 2017, 28(8): 1700-1712.
[8]
Stockwell S. Classics in oncology. George Thomas Beatson, M.D. (1848-1933) [J]. CA Cancer J Clin, 1983, 33(2): 105-121.
[9]
Hanker AB, Sudhan DR, Arteaga CL. Overcoming endocrine resistance in breast cancer [J]. Cancer Cell, 2020, 37(4): 496-513.
[10]
Ingle JN, Ahmann DL, Green SJ, et al. Randomized clinical trial of diethylstilbestrol versus tamoxifen in postmenopausal women with advanced breast cancer [J]. N Engl J Med, 1981, 304(1): 16-21.
[11]
Waks AG, Winer EP. Breast cancer treatment: a review [J]. JAMA, 2019, 321(3): 288-300.
[12]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials [J]. Lancet, 2005, 365(9472): 1687-1717.
[13]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials [J]. Lancet, 2015, 386(10001): 1341-1352.
[14]
Swain SM, Jeong JH, Geyer CE Jr, et al. Longer therapy, iatrogenic amenorrhea, and survival in early breast cancer [J]. N Engl J Med, 2010, 362(22): 2053-2065.
[15]
Pagani O, Francis PA, Fleming GF, et al. Absolute improvements in freedom from distant recurrence to tailor adjuvant endocrine therapies for premenopausal women: results from TEXT and SOFT [J]. J Clin Oncol, 2020, 38(12): 1293-1303.
[16]
Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up [J]. Ann Oncol, 2019, 30(10): 1674.
[17]
Burstein HJ, Lacchetti C, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology clinical practice guideline update on ovarian suppression [J]. J Clin Oncol, 2016, 34(14): 1689-1701.
[18]
Davies C, Godwin J, Gray R, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials [J]. Lancet, 2011, 378(9793): 771-784.
[19]
Cuzick J, Sestak I, Baum M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial [J]. Lancet Oncol, 2010, 11(12): 1135-1141.
[20]
Thürlimann B, Keshaviah A, Coates AS, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer [J]. N Engl J Med, 2005, 353(26): 2747-2757.
[21]
Van De Velde CJ, Rea D, Seynaeve C, et al. Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial [J]. Lancet, 2011, 377(9762): 321-331.
[22]
Derks MGM, Blok EJ, Seynaeve C, et al. Adjuvant tamoxifen and exemestane in women with postmenopausal early breast cancer (TEAM): 10-year follow-up of a multicentre, open-label, randomised, phase 3 trial [J]. Lancet Oncol, 2017, 18(9): 1211-1220.
[23]
Dowsett M, Cuzick J, Ingle J, et al. Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen [J]. J Clin Oncol, 2010, 28(3): 509-518.
[24]
Davies C, Pan H, Godwin J, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial [J]. Lancet, 2013, 381(9869): 805-816.
[25]
Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors [J]. J Natl Cancer Inst, 1996, 88(21): 1529-1542.
[26]
Stewart HJ, Forrest AP, Everington D, et al. Randomised comparison of 5 years of adjuvant tamoxifen with continuous therapy for operable breast cancer. The Scottish Cancer Trials Breast Group [J]. Br J Cancer, 1996, 74(2): 297-299.
[27]
Tormey DC, Gray R, Falkson HC. Postchemotherapy adjuvant tamoxifen therapy beyond five years in patients with lymph node-positive breast cancer. Eastern Cooperative Oncology Group [J]. J Natl Cancer Inst, 1996, 88(24): 1828-1833.
[28]
Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update [J]. J Clin Oncol, 2014, 32(21): 2255-2269.
[29]
Goss PE, Ingle JN, Martino S, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17 [J]. J Natl Cancer Inst, 2005, 97(17): 1262-1271.
[30]
Mamounas EP, Jeong JH, Wickerham DL, et al. Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intention-to-treat analysis of the National Surgical Adjuvant Breast And Bowel Project B-33 trial [J]. J Clin Oncol, 2008, 26(12): 1965-1971.
[31]
Jakesz R, Greil R, Gnant M, et al. Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a [J]. J Natl Cancer Inst, 2007, 99(24): 1845-1853.
[32]
Burstein HJ, Lacchetti C, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: ASCO clinical practice guideline focused update [J]. J Clin Oncol, 2019, 37(5): 423-438.
[33]
Fisher B, Dignam J, Wolmark N, et al. Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer [J]. J Natl Cancer Inst, 1997, 89(22): 1673-1682.
[34]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials [J]. Lancet, 2012, 379(9814): 432-444.
[35]
Rubens RD, Sexton S, Tong D, et al. Combined chemotherapy and radiotherapy for locally advanced breast cancer [J]. Eur J Cancer, 1980, 16(3): 351-356.
[36]
Clough KB, Acosta-Marín V, Nos C, et al. Rates of neoadjuvant chemotherapy and oncoplastic surgery for breast cancer surgery: a French national survey [J]. Ann Surg Oncol, 2015, 22(11): 3504-3511.
[37]
Vugts G, Maaskant-Braat AJ, Nieuwenhuijzen GA, et al. Patterns of care in the administration of neo-adjuvant chemotherapy for breast cancer. A population-based study [J]. Breast J, 2016, 22(3): 316-321.
[38]
Mougalian SS, Soulos PR, Killelea BK, et al. Use of neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States [J]. Cancer, 2015, 121(15): 2544-2552.
[39]
Fisher B, Gunduz N, Coyle J, et al. Presence of a growth-stimulating factor in serum following primary tumor removal in mice [J]. Cancer Res, 1989, 49(8): 1996-2001.
[40]
Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis [J]. Lancet, 2014, 384(9938): 164-172.
[41]
Von Minckwitz G, Blohmer JU, Costa SD, et al. Response-guided neoadjuvant chemotherapy for breast cancer [J]. J Clin Oncol, 2013, 31(29): 3623-3630.
[42]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials [J]. Lancet Oncol, 2018, 19(1): 27-39.
[43]
Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer [J]. N Engl J Med, 2004, 351(27): 2817-2826.
[44]
Kwa M, Makris A, Esteva FJ. Clinical utility of gene-expression signatures in early stage breast cancer [J]. Nat Rev Clin Oncol, 2017, 14(10): 595-610.
[45]
Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer [J]. J Clin Oncol, 2006, 24(23): 3726-3734.
[46]
Albain KS, Barlow WE, Shak S, et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial [J]. Lancet Oncol, 2010, 11(1): 55-65.
[47]
Sparano JA, Paik S. Development of the 21-gene assay and its application in clinical practice and clinical trials [J]. J Clin Oncol, 2008, 26(5): 721-728.
[48]
Van’T Veer LJ, Dai H, Van De Vijver MJ, et al. Gene expression profiling predicts clinical outcome of breast cancer [J]. Nature, 2002, 415(6871): 530-536.
[49]
Cardoso F, Van’t Veer LJ, Bogaerts J, et al. 70-gene signature as an aid to treatment decisions in early-stage breast cancer [J]. N Engl J Med, 2016, 375(8): 717-729.
[50]
Andre F, Ismaila N, Henry NL, et al. Use of Biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: ASCO clinical practice guideline update-integration of results from TAILORx [J]. J Clin Oncol, 2019, 37(22): 1956-1964.
[51]
Mcandrew NP, Finn RS. Management of ER positive metastatic breast cancer [J]. Semin Oncol, 2020, 47(5): 270-277.
[52]
Cardoso F, Costa A, Norton L, et al. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)? [J]. Ann Oncol, 2014, 25(10): 1871-1888.
[53]
Xu HB, Liu YJ, Li L. Aromatase inhibitor versus tamoxifen in postmenopausal woman with advanced breast cancer: a literature-based meta-analysis [J]. Clin Breast Cancer, 2011, 11(4): 246-251.
[54]
Mauri D, Pavlidis N, Polyzos NP, et al. Survival with aromatase inhibitors and inactivators versus standard hormonal therapy in advanced breast cancer: meta-analysis [J]. J Natl Cancer Inst, 2006, 98(18): 1285-1291.
[55]
Schiavon G, Smith IE. Endocrine therapy for advanced/metastatic breast cancer [J]. Hematol Oncol Clin North Am, 2013, 27(4): 715-736; 715-736, viii.
[56]
Di Leo A, Jerusalem G, Petruzelka L, et al. Results of the CONFIRM phase III trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer [J]. J Clin Oncol, 2010, 28(30): 4594-4600.
[57]
Robinson DR, Wu YM, Vats P, et al. Activating ESR1 mutations in hormone-resistant metastatic breast cancer [J]. Nat Genet, 2013, 45(12): 1446-1451.
[58]
Jeselsohn R, Buchwalter G, De Angelis C, et al. ESR1 mutations—a mechanism for acquired endocrine resistance in breast cancer [J]. Nat Rev Clin Oncol, 2015, 12(10): 573-583.
[59]
Baselga J, Campone M, Piccart M, et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer [J]. N Engl J Med, 2012, 366(6): 520-529.
[60]
Piccart M, Hortobagyi GN, Campone M, et al. Everolimus plus exemestane for hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: overall survival results from BOLERO-2? [J]. Ann Oncol, 2014, 25(12): 2357-2362.
[61]
Rugo HS, Rumble RB, Macrae E, et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology guideline [J]. J Clin Oncol, 2016, 34(25): 3069-3103.
[62]
Klijn JG, Blamey RW, Boccardo F, et al. Combined tamoxifen and luteinizing hormone-releasing hormone (LHRH) agonist versus LHRH agonist alone in premenopausal advanced breast cancer: a meta-analysis of four randomized trials [J]. J Clin Oncol, 2001, 19(2): 343-353.
[63]
Pagani O, Regan MM, Walley BA, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer [J]. N Engl J Med, 2014, 371(2): 107-118.
[64]
Chun KH, Park JH, Fan S. Predicting and overcoming chemotherapeutic resistance in breast cancer [J]. Adv Exp Med Biol, 2017, 1026: 59-104.
[65]
Klinge CM. Estrogen receptor interaction with estrogen response elements [J]. Nucleic Acids Res, 2001, 29(14): 2905-2919.
[66]
Marino M, Galluzzo P, Ascenzi P. Estrogen signaling multiple pathways to impact gene transcription [J]. Curr Genomics, 2006, 7(8): 497-508.
[67]
Araki K, Miyoshi Y. Mechanism of resistance to endocrine therapy in breast cancer: the important role of PI3K/Akt/mTOR in estrogen receptor-positive, HER2-negative breast cancer [J]. Breast Cancer, 2018, 25(4): 392-401.
[68]
Telang NT. The Divergent effects of ovarian steroid hormones in the MCF-7 model for luminal a breast cancer: mechanistic leads for therapy [J]. Int J Mol Sci, 2022, 23(9): 4800.
[69]
Van Der Spek YM, Kroep JR, Tollenaar R, et al. Chemotherapy resistance and stromal targets in breast cancer treatment: a review [J]. Mol Biol Rep, 2020, 47(10): 8169-8177.
[70]
Kumar U, Ardasheva A, Mahmud Z, et al. FOXA1 is a determinant of drug resistance in breast cancer cells [J]. Breast Cancer Res Treat, 2021, 186(2): 317-326.
[71]
Zeng J, Li G, Xia Y, et al. miR-204/COX5A axis contributes to invasion and chemotherapy resistance in estrogen receptor-positive breast cancers [J]. Cancer Lett, 2020, 492: 185-196.
[72]
Tang H, Chen J, Wang L, et al. Co-delivery of epirubicin and paclitaxel using an estrone-targeted PEGylated liposomal nanoparticle for breast cancer [J]. Int J Pharm, 2020, 573: 118 806.
[73]
Wang S, Lee D. Identifying prognostic subgroups of luminal-A breast cancer using deep autoencoders and gene expressions [J]. PLoS Comput Biol, 2023, 19(5): e1011197.
[74]
Yu D, Liu S, Chen Y, et al. Integrative bioinformatics analysis reveals CHEK1 and UBE2C as luminal A breast cancer subtype biomarkers [J]. Front Genet, 2022, 13: 944259.
[75]
Jia X, Lei H, Jiang X, et al. Identification of crucial lncRNAs for luminal A breast cancer through RNA sequencing [J]. Int J Endocrinol, 2022, 2022: 6577942.
[76]
Ahn S, Kwon A, Huh YH, et al. Tumor-derived miR-130b-3p induces cancer-associated fibroblast activation by targeting SPIN90 in luminal A breast cancer [J]. Oncogenesis, 2022, 11(1): 47.
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