The use of neoadjuvant systemic therapy (NST) has become increasingly important in the treatment of breast cancer because of its various advantages. These include the ability to downstage tumors without compromising locoregional control and the potential to obtain valuable information about clinical and biological response to therapy with implications for individual prognoses. Surgical response assessment paves the way for response-adapted therapy, and pathological complete response (pCR; defined as ypT0/is ypN0) serves as an additional endpoint for drug development trials. Recommended NST regimens commonly consist of anthracyclines and taxane, with dose-dense anthracyclines and weekly paclitaxel often preferred, whenever feasible. For patients with human epidermal growth factor receptor-2 (HER2)-positive tumors, dual anti-HER2 therapy (trastuzumab and pertuzumab) is indicated together with NST in case of elevated risk of recurrence. For patients with triple-negative breast cancer (TNBC), adding carboplatin to NST correlates with improved pCR and survival rates, as does the addition of immune checkpoint inhibitors. For hormone receptor (HR)-positive/HER2-negative cancers, emerging data on NST including immune checkpoint inhibitors may elevate the significance of NST in high-risk luminal breast cancer. Here, we present a synthesis of the results from neoadjuvant clinical trials that aim at optimizing treatment options for patients with high-risk breast cancer.
新辅助全身治疗（NST）因其多重优势，在乳腺癌治疗中的地位日益重要。这些优势包括在不影响局部区域控制的前提下实现肿瘤降期，以及获取关于治疗临床与生物学反应的宝贵信息，从而为个体预后评估提供依据。手术反应评估为反应适应性治疗奠定了基础，而病理完全缓解（pCR；定义为ypT0/is ypN0）则成为药物研发试验的重要终点指标。推荐的新辅助治疗方案通常包含蒽环类和紫杉类药物，在可行情况下常优先采用剂量密集型蒽环类药物联合周疗紫杉醇方案。对于人表皮生长因子受体2（HER2）阳性肿瘤患者，若存在较高复发风险，建议在NST基础上联合双重抗HER2治疗（曲妥珠单抗与帕妥珠单抗）。对于三阴性乳腺癌（TNBC）患者，在NST基础上加用卡铂或免疫检查点抑制剂均能提高pCR率并改善生存预后。对于激素受体（HR）阳性/HER2阴性乳腺癌，新兴数据显示包含免疫检查点抑制剂的NST方案可能提升该疗法在高风险管腔型乳腺癌中的治疗价值。本文系统综述了新辅助临床试验的研究成果，旨在为高风险乳腺癌患者优化治疗方案提供依据。
Shifting the Paradigm: The Transformative Role of Neoadjuvant Therapy in Early Breast Cancer
肿瘤(癌症)患者之家