De-escalation is currently taking place in both the surgical and systemic treatment of breast cancer. The introduction of trastuzumab, the first monoclonal antibody against the HER2 receptor, over 20 years ago was a milestone in the treatment of HER2-positive breast cancer and marked the beginning of a new era in targeted tumor therapy. In the sense of de-escalation, omitting non-targeted cytotoxic chemotherapy altogether is often hailed as the ultimate goal of oncological research. Especially in cases of small, node-negative, HER2-positive early breast cancer, it remains a challenge for clinicians to establish the safest and most efficient treatment plan while considering the significant potential for toxic side effects associated with chemotherapy and HER2-targeted therapy, and the generally excellent prognosis. In this context, several ongoing studies are currently assessing chemotherapy-free regimens as part of strategies aimed at de-escalating therapy in the field of HER2-positive early breast cancer. Despite the promising early results of these studies, the combination of anti-HER2 treatment with a chemotherapy backbone remains the standard of care.
在乳腺癌的手术和全身治疗领域，降阶梯治疗策略正在逐步推进。二十多年前，首个针对HER2受体的单克隆抗体曲妥珠单抗的问世，成为HER2阳性乳腺癌治疗史上的里程碑，标志着肿瘤靶向治疗新时代的开启。在降阶梯治疗理念下，完全省略非靶向细胞毒性化疗常被视为肿瘤学研究的终极目标。尤其对于肿瘤较小、淋巴结阴性、HER2阳性的早期乳腺癌患者而言，临床医生在制定治疗方案时面临重大挑战：一方面需要权衡化疗及HER2靶向治疗可能带来的显著毒副作用，另一方面此类患者通常预后良好。在此背景下，多项正在进行的研究正在评估无化疗方案作为HER2阳性早期乳腺癌降阶梯治疗策略的组成部分。尽管这些研究已显示出令人鼓舞的早期成果，抗HER2治疗联合化疗方案目前仍是标准治疗方案。
HER2-Positive Early Breast Cancer: Time for Ultimate De-Escalation?
肿瘤(癌症)患者之家