乳腺癌全身治疗的进展
完整摘要 · 中文译文
乳腺癌的全身治疗自2020年以来迅速发展，其驱动力来自靶向治疗、抗体药物偶联物和免疫疗法在各生物学亚型中的扩展。肿瘤分子谱分析和胚系检测的整合已使得日益个体化、以生物标志物为指导的治疗策略成为可能。在激素受体阳性、人表皮生长因子受体2（HER2）阴性疾病中，细胞周期蛋白依赖性激酶4和6抑制剂仍是基础治疗，而磷脂酰肌醇3-激酶通路抑制剂、口服选择性雌激素受体降解剂和抗体药物偶联物已改变了内分泌耐药后的疾病管理。在HER2阳性疾病中，抗体药物偶联物——特别是德曲妥珠单抗——已改善结局，并被用于更早线的治疗，这一进展正在重塑治疗范式。在三阴性乳腺癌中，免疫检查点抑制剂已改善转移性和早期疾病的结局。在各亚型中，治愈性治疗的进展日益强调基于风险的升阶梯和降阶梯治疗。持续的挑战包括改进治疗顺序、识别预测性生物标志物、整合循环肿瘤DNA分析等新兴工具，以及确保公平获得高成本疗法。
完整摘要 · 英文原文
Systemic therapy for breast cancer has evolved rapidly since 2020, driven by the expansion of targeted therapies, antibody-drug conjugates, and immunotherapy across biologic subtypes. The integration of tumor molecular profiling and germline testing has enabled increasingly personalized, biomarker-guided treatment strategies. In hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative disease, cyclin-dependent kinase 4 and 6 inhibitors remain foundational, whereas phosphatidylinositol 3-kinase pathway inhibitors, oral selective estrogen-receptor degraders, and antibody-drug conjugates have transformed disease management after endocrine resistance. In HER2-positive disease, antibody-drug conjugates - particularly trastuzumab deruxtecan - have improved outcomes and are being used in earlier lines of therapy, a development that is reshaping treatment paradigms. In triple-negative breast cancer, immune checkpoint inhibitors have improved outcomes in both metastatic and early-stage disease. Across subtypes, advances in curative therapy increasingly emphasize risk-adapted escalation and de-escalation of treatment. Ongoing challenges include improving treatment sequencing, identifying predictive biomarkers, integrating emerging tools such as analysis of circulating tumor DNA, and ensuring equitable access to high-cost therapies.