The concept of “more is better” has long dominated cancer treatment, emphasizing aggressive therapies despite their toxicity. However, the rise of personalized medicine has fostered treatment de-escalation strategies aimed at minimizing toxicity, improving quality of life, and reducing costs. This position paper highlights key applications of de-escalation in medical oncology, with a primary focus on breast cancer and notable examples in colorectal, head and neck, ovarian, lung, and prostate cancers. Various approaches, including dose reduction, treatment duration shortening, and regimen optimization, have demonstrated efficacy without compromising clinical outcomes. Advances in molecular diagnostics, such as Oncotype Dx in breast cancer and circulating tumor DNA (ctDNA) analysis in colorectal cancer, have facilitated patient selection for de-escalation. While these strategies present promising results, challenges remain, particularly in balancing treatment intensity with oncologic control. The review underscores the need for further prospective trials to refine de-escalation approaches and ensure their safe integration into standard oncologic care.
长期以来，“越多越好”的理念主导着癌症治疗，强调即使存在毒性也要采取激进疗法。然而，随着个体化医疗的兴起，降阶梯治疗策略逐渐发展，旨在降低治疗毒性、改善患者生活质量并减少医疗成本。本立场文件重点阐述了降阶梯治疗在肿瘤内科中的关键应用，主要聚焦于乳腺癌领域，并列举了结直肠癌、头颈癌、卵巢癌、肺癌和前列腺癌中的典型案例。包括剂量降低、疗程缩短和方案优化在内的多种方法，已被证实能在不影响临床疗效的前提下实现治疗目标。分子诊断技术的进步，如乳腺癌的Oncotype Dx检测和结直肠癌的循环肿瘤DNA（ctDNA）分析，为降阶梯治疗的患者筛选提供了支持。尽管这些策略展现出良好前景，但仍面临挑战，尤其是在平衡治疗强度与肿瘤控制方面。本文强调需要进一步开展前瞻性临床试验，以完善降阶梯治疗方案，确保其安全融入标准肿瘤诊疗体系。
肿瘤(癌症)患者之家