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中华乳腺病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 78 -84. doi: 10.3877/cma.j.issn.1674-0807.2024.02.004

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晚期三阴性乳腺癌的精准治疗
陈文艳1,(), 汪云1, 魏松之1   
  1. 1. 330399 南昌市人民医院乳腺肿瘤内科
  • 收稿日期:2024-03-25 出版日期:2024-04-01
  • 通信作者: 陈文艳

Precision treatment for advanced triple negative breast cancer

Wenyan Chen1,(), Yun Wang1, Songzhi Wei1   

  1. 1. Department of Breast Oncology, Nanchang People’s Hospital, Nanchang 330399, China
  • Received:2024-03-25 Published:2024-04-01
  • Corresponding author: Wenyan Chen
引用本文:

陈文艳, 汪云, 魏松之. 晚期三阴性乳腺癌的精准治疗[J]. 中华乳腺病杂志(电子版), 2024, 18(02): 78-84.

Wenyan Chen, Yun Wang, Songzhi Wei. Precision treatment for advanced triple negative breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(02): 78-84.

三阴性乳腺癌(TNBC)的定义是基于肿瘤中缺失3个主要的生长驱动分子标志物:ER、PR和HER-2。因此,TNBC被认为是一种生物特性相对不明确的、异质性很强的疾病。同时,TNBC是所有分子亚型中预后最差的,特别是晚期TNBC患者的5年生存率仅为12%左右。随着对TNBC生物学特征的持续深入了解,个性化治疗策略越来越被重视,从而推动了TNBC治疗模式不断向精准治疗的转变。精准治疗是基于确定的生物标志物,通过预测特定患者群体对靶向治疗的反应来实施的肿瘤治疗策略。目前,临床研究的重点已经转向识别具有潜在药物靶点的生物标志物,例如免疫检查点抑制剂、靶向治疗药物和抗体药物偶联物,这些都已成为治疗决策的重要组成部分。随着对TNBC亚型更精确的分类和治疗方案的不断完善,晚期TNBC患者有望获得更为精准的诊断和治疗。

Triple negative breast cancer (TNBC) is defined by the absence of three primary growth driver markers in the tumor: ER, PR, and HER-2. Therefore, TNBC is considered as a disease with undefined biological characteristics and high heterogeneity. Among all molecular subtypes, TNBC has the poorest prognosis, and the 5-year survival rate of advanced TNBC patients is about 12%. With the in-depth understanding of the biological characteristics of TNBC, personalized treatment draws more and more attention, thus promoting the continuous transition of TNBC treatment modes towards precision medicine. Precision treatment is to predict the response of certain patient groups to targeted therapy based on expression of identified biomarkers, Currently, the focus of clinical researches has shifted to identifying biomarkers with potential drug targets, such as immune checkpoint inhibitors, targeted therapeutic drugs and antibody-drug conjugates, which have become indispensable in the decision-making in the treatment. With more precise classification of TNBC subtypes and continuous improvement of treatment strategies, patients with advanced TNBC are expected to have more accurate diagnosis and precise treatment.

[1]
Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[EB/OL]. [2024-03-12].

URL    
[2]
Bianchini G, Balko JM, Mayer IA, et al. Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease[J]. Nat Rev Clin Oncol, 2016, 13 (11): 674-690.
[3]
Sivina E, Blumberga L, Purkalne G, et al. Pathological complete response to neoadjuvant chemotherapy in triple negative breast cancer-single hospital experience[J]. Hered Cancer Clin Pract202321(1):4.
[4]
Lin Y, Yin W, Yan T, et al. Site-specific relapse pattern of the triple negative tumors in Chinese breast cancer patients[J]. BMC Cancer, 2009, 9:342.
[5]
丁欣韵,孙洁,陈久安,等.BRCA1/2突变异时性双乳癌首发癌和对侧癌的临床病理特征对比研究[J].肿瘤防治研究202350(7):652-657.
[6]
Bianchini G, Balko JM, Mayer IA, et al. Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease[J]. Nat Rev Clin Oncol, 2016, 13(11):674-690.
[7]
Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer[J]. N Engl J Med, 2010, 363 (20): 1938-1948.
[8]
Lin NU, Vanderplas A, Hughes ME, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network[J]. Cancer, 2012, 118(22): 5463-5472.
[9]
Bardia A, Hurvitz SA, Tolaney SM, et al. Sacituzumab govitecan in metastatic triple-negative breast cancer[J]. N Engl J Med2021, 384(16): 1529-1541.
[10]
Cortes J, Rugo HS, Cescon DW, et al. Pembrolizumab plus chemotherapy in advanced triple-negative breast cancer[J]. N Engl J Med, 2022, 387(3): 217-226.
[11]
National Cancer Institute. SEER cancer stat facts: female breast cancer subtypes[EB/OL].[2024-03-12].

URL    
[12]
Perou CM, Srlie T, Eisen MB, et al. Molecular portraits of human breast tumours[J]. Nature, 2000, 406(6797): 747-752.
[13]
Gennari A, André F, Barrios CH, et al. ESMO metastatic breast cancer living guidelines[EB/OL].[2024-03-12].

URL    
[14]
中国抗癌协会乳腺癌专业委员会,中华医学会肿瘤学分会乳腺肿瘤学组. 中国抗癌协会乳腺癌诊治指南与规范(2024年版)[J]. 中国癌症杂志2023, 33(12): 1092-1187.
[15]
Emens LA, Adams S, Barrios CH, et al. LBA16 IMpassion130: final OS analysis from the pivotal phase III study of atezolizumab+ nab-paclitaxel vs placebo+ nab-paclitaxel in previously untreated locally advanced or metastatic triple-negative breast cancer[J]. Ann Oncol, 2020, 31: S1148.
[16]
Miles D, Gligorov J, André F, et al. Primary results from IMpassion131, a double-blind, placebo-controlled, randomised phase III trial of first-line paclitaxel with or without atezolizumab for unresectable locally advanced/metastatic triple-negative breast cancer[J]. Ann Oncol, 2021, 32(8): 994-1004.
[17]
Cortes J, Cescon DW, Rugo HS, et al. Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial[J].Lancet, 2020, 396(10 265): 1817-1828.
[18]
Jiang Z, Ouyang Q, Sun T, et al. Toripalimab plus nab-paclitaxel in metastatic or recurrent triple-negative breast cancer: a randomized phase 3 trial[J]. Nat Med202430(1):249-256.
[19]
Szekely B, Bossuyt V, Li X, et al. Immunological differences between primary and metastatic breast cancer[J]. Ann Oncol, 2018, 29(11): 2232-2239.
[20]
Bianchini G, De Angelis C, Licata L, et al. Treatment landscape of triple-negative breast cancer—expanded options, evolving needs[J]. Nat Rev Clin Oncol, 2022, 19(2): 91-113.
[21]
Ghiringhelli F, Menard C, Puig PE, et al. Metronomic cyclophosphamide regimen selectively depletes CD4+ CD25+ regulatory T cells and restores T and NK effector functions in end stage cancer patients[J]. Cancer Immunol Immunother, 2007, 56: 641-648.
[22]
宋娜娜,方峻.节拍化疗对免疫系统的影响[J].临床内科杂志201936(5)293-296.
[23]
Mo H, Sun X, Zhai J, et al.Efficacy, safety of toripalimab plus metronomic chemotherapy for Her2-negative metastatic breast cancer[EB/OL].[2024-03-15].

URL    
[24]
Wang L, Geng H, Liu Y, et al. Hot and cold tumors: immunological features and the therapeutic strategies[J]. MedComm, 2023, 4(5): e343.
[25]
Benoit A, Vogin G, Duhem C, et al. Lighting up the fire in the microenvironment of cold tumors: a major challenge to improve cancer immunotherapy[J]. Cells, 2023, 12(13): 1787.
[26]
Adams E, Wildiers H, Neven P, et al. Sacituzumab govitecan and trastuzumab deruxtecan: two new antibody-drug conjugates in the breast cancer treatment landscape[J]. ESMO open, 2021, 6(4): 100 204.
[27]
Díaz-Rodríguez E, Gandullo-Sánchez L, Ocaña A, et al. Novel ADCs and strategies to overcome resistance to anti-HER2 ADCs[J]. Cancer, 2021, 14(1): 154.
[28]
Goldenberg DM, Stein R, Sharkey RM. The emergence of trophoblast cell-surface antigen 2 (TROP-2) as a novel cancer target[J]. Oncotarget, 2018, 9(48): 28 989.
[29]
Goldenberg DM, Cardillo TM, Govindan SV, et al. Trop-2 is a novel target for solid cancer therapy with sacituzumab govitecan (IMMU-132), an antibody-drug conjugate (ADC)[J]. Oncotarget, 2015, 6(26): 22 496.
[30]
Bardia A, Hurvitz SA, Tolaney SM, et al. Sacituzumab govitecan in metastatic triple-negative breast cancer[J]. N Engl J Med, 2021, 384(16): 1529-1541.
[31]
Xu B, Ma F, Wang T, et al. A Phase IIb, single arm, multicenter trial of sacituzumab govitecan in Chinese patients with metastatic triple-negative breast cancer who received at least two prior treatments[J]. Int J Cancer, 2023, 152(10): 2134-2144.
[32]
Fei M, Shusen W, Zhongsheng T, et al. Overall survival results from EVER-132-001, a phase 2b single-arm study of sacituzumab govitecan in Chinese patients with metastatic triple-negative breast cancer[EB/OL].[2024-03-13].

URL    
[33]
Jiangping Y, Xi Y, Jinlan H, et al. Treatment and prognosis of advanced triple-negative breast cancer patients with HER-2-low expression: a 15-year retrospective study[EB/OL].[2024-03-13]

URL    
[34]
Miglietta F, Griguolo G, Bottosso M, et al. Evolution of HER2-low expression from primary to recurrent breast cancer[J]. NPJ breast cancer, 2021, 7(1): 137.
[35]
Xu B, Ma F, Wang S, et al. 22MO efficacy and safety of sacituzumab govitecan in Chinese patients with metastatic triple-negative breast cancer (mTNBC) by baseline HER2 expression level: subgroup analysis from a phase IIb trial[EB/OL].[2024-03-13].

URL    
[36]
Yin YM, Wu XH, Ouyang Q, et al. Updated efficacy and safety of SKB264 (MK-2870) for previously treated metastatic triple negative breast cancer (mTNBC) in Phase 2 study. [EB/OL].[2024-01-24].

URL    
[37]
Schmid P, Wysocki PJ, Ma CX, et al. Datopotamab deruxtecan (Dato-DXd)+ durvalumab (D) as first-line (1L) treatment for unresectable locally advanced/metastatic triple-negative breast cancer (a/mTNBC): updated results from BEGONIA, a phase Ib/II study[EB/OL].[2024-01-24].

URL    
[38]
Ma D, Chen SY, Ren JX, et al. Molecular features and functional implications of germline variants in triple-negative breast cancer [J]. J Natl Cancer Inst2021113(7):884-892.
[39]
Robson M, Im SA, Senkus E, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation[J]. N Engl J Med, 2017, 377(6): 523-533.
[40]
Robson ME, Im SA, Senkus E, et al. OlympiAD extended follow-up for overall survival and safety: Olaparib versus chemotherapy treatment of physician’s choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer[J]. Eur J Cancer, 2023, 184: 39-47.
[41]
Rodler E, Sharma P, Barlow WE, et al. Cisplatin with veliparib or placebo in metastatic triple-negative breast cancer and BRCA mutation-associated breast cancer (S1416): a randomised, double-blind, placebo-controlled, phase 2 trial[J]. Lancet Oncol, 2023, 24(2): 162-174.
[42]
邵笛,余天剑,邵志敏.三阴性乳腺癌精准治疗研究进展[J].中国普通外科杂志202332(11):1629-1638.
[43]
Perou CM, Srlie T, Eisen MB, et al. Molecular portraits of human breast tumours[J]. Nature, 2000, 406(6797): 747-752.
[44]
Grinda T, Antoine A, Jacot W, et al. Evolution of overall survival and receipt of new therapies by subtype among 20 446 metastatic breast cancer patients in the 2008-2017 ESME cohort[J]. ESMO open, 2021, 6(3): 100114.
[45]
Jiang YZ, Ma D, Suo C, et al. Genomic and transcriptomic landscape of triple-negative breast cancers: subtypes and treatment strategies[J]. Cancer cell, 2019, 35(3): 428-440.
[46]
Zhou H, Zhu L, Song J, et al. Liquid biopsy at the frontier of detection, prognosis and progression monitoring in colorectal cancer[J]. Mol Cancer, 2022, 21(1): 86.
[47]
Jin X, Zhou YF, Ma D, et al. Molecular classification of hormone receptor-positive HER2-negative breast cancer[J]. Nat Genet, 2023, 55(10): 1696-1708.
[48]
Chen L, Jiang YZ, Wu SY, et al. Famitinib with camrelizumab and nab-paclitaxel for advanced immunomodulatory triple-negative breast cancer (FUTURE-C-Plus): an open-label, single-arm, phase II trial[J]. Clin Cancer Res, 2022, 28(13): 2807-2817.
[49]
Fan L, Wang ZH, Ma LX, et al. Optimising first-line subtyping-based therapy in triple-negative breast cancer (FUTURE-SUPER): a multi-cohort, randomised, phase 2 trial[J]. Lancet Oncol, 2024, 25(2): 184-197.
[50]
Shao ZM, Fan L, Ma LX, et al. FUTURE-SUPER: A randomized, subtyping-based umbrella phase II trial for first-line treatment of metastatic triple-negative breast cancer [EB/OL].[2024-03-12].

URL    
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[2] 梁旭, 宋国红. 2023年激素受体阳性/HER-2阴性乳腺癌治疗的研究进展[J]. 中华乳腺病杂志(电子版), 2024, 18(02): 71-77.
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