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中华乳腺病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 129 -138. doi: 10.3877/cma.j.issn.1674-0807.2025.03.001

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局部晚期HER-2阳性乳腺癌的新辅助治疗
姜明霞, 李俏, 徐兵河()   
  1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤内科
  • 收稿日期:2025-02-06 出版日期:2025-06-01
  • 通信作者: 徐兵河
  • 基金资助:
    中国医学科学院医学与健康科技创新工程资助项目(2021-I2M-1-014;2023-I2M-C&T-B-096)

Preoperative treatment for locally advanced HER-2-positive breast cancer

Mingxia Jiang, Qiao Li, Binghe Xu()   

  1. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2025-02-06 Published:2025-06-01
  • Corresponding author: Binghe Xu
引用本文:

姜明霞, 李俏, 徐兵河. 局部晚期HER-2阳性乳腺癌的新辅助治疗[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(03): 129-138.

Mingxia Jiang, Qiao Li, Binghe Xu. Preoperative treatment for locally advanced HER-2-positive breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(03): 129-138.

HER-2阳性局部晚期乳腺癌(LABC)因高侵袭性及易耐药性成为治疗难点,当前双靶治疗(曲妥珠+帕妥珠单克隆抗体)联合化疗虽将病理完全缓解率提升至40%~60%,但复发风险仍存。近年来,新辅助治疗策略革新成效显著:高载药比及旁观者效应显著的抗体偶联药物,如德曲妥珠单克隆抗体,显著提高了疗效;酪氨酸激酶抑制剂及双特异性抗体通过多通路协同抑制,提高了整体抗肿瘤活性。同时,化疗降阶策略如通过影像代谢评估筛选的"去化疗"方案、免疫治疗的加入以及针对三阳性乳腺癌的全口服方案,显著扩展了个体化治疗路径。未来需通过多组学生物标志物筛选、优化靶向药物设计及全程管理策略,进一步克服耐药性并平衡疗效与生活质量,最终实现精准治疗突破。

HER-2-positive locally advanced breast cancer (LABC) remains challenging to treat due to its aggressive biology and propensity for drug resistance. Currently, dual-targeted therapy (trastuzumab plus pertuzumab) combined with chemotherapy has increased pCR rates to 40%-60%; however, the risk of recurrence persists. Recently, significant advances have been made in preoperative treatment strategies, antibody-drug conjugates with high drug-to-antibody ratios and pronounced bystander effects, such as trastuzumab deruxtecan, have markedly enhanced therapeutic efficacy; tyrosine kinase inhibitors and bispecific antibodies have improved overall anti-tumor activity through multi-pathway synergistic inhibition. Additionally, chemotherapy de-escalation approaches, such as chemo-free regimens selected by imaging and metabolic assessment, the incorporation of immunotherapy, and fully oral regimens for triple-positive breast cancer, have significantly broadened personalized treatment options. Future efforts should focus on the identification of multi-omics biomarkers, optimization of targeted therapies and comprehensive management strategies to further overcome resistance, balance efficacy and quality of life, and ultimately achieve breakthroughs in precision oncology.

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