Оценка риска рецидива люминального HER2-отрицательного рака молочной железы и возможности интенсификации адъювантной гормонотерапии для снижения риска прогрессирования
Основой лечения люминального HER2-отрицательного рака молочной железы (РМЖ) – самого распространенного подтипа РМЖ – является гормонотерапия, которую назначают на 5–10 лет после проведения радикального лечения. Несмотря на проведение такого длительного лечения, одна из 3–4 пациенток со II стадией и одна из 2–3 пациенток с III стадией сталкиваются с рецидивом, который может произойти в течение 20 лет после постановки первичного диагноза. Риск рецидива зависит от таких характеристик опухоли, как степень злокачественности, уровень пролиферативной активности, степень поражения регионарных лимфатических узлов и др. С целью снижения этого риска на данный момент используется несколько стратегий интенсификации адъювантной гормональной терапии. К ним относятся овариальная супрессия, продленное назначение гормональной терапии, а также назначение ингибиторов CDK4/6. В данной статье представлен обзор факторов риска рецидива и существующих на данный момент стратегий адъювантной гормонотерапии.Гордеева О.О.
Ключевые слова
рак молочной железы
люминальный HER2-отрицательный рак молочной железы
адъювантная гормональная терапия
овариальная супрессия
ингибиторы CDK4/6
Список литературы
1. Злокачественные новообразования в России в 2021 г. (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М., 2023. 250 с. Malignant neoplasms in Russia in 2021 (morbidity and mortality). Edited by A.D. Kaprin, V.V. Starinsky, G.V. Petrova. Moscow, 2023. 250 p.
2. Torre L.A., Bray F., Siegel R.L., et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.
3. GLOBOCAN: Estimated Cancer Incidence, Mortality and Prevalence Worldwide 2012
4. Siegel R.L., Miller K.D., Jemal A.: Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.
5. Perou C.M., Sorlie T., Eisen M.B., et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747–52.
6. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer Version 2.2024. 2024 March 11.
7. Loibl S., Andre F., Bachelot T., et al. ESMO Guidelines Committee. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159–82. Doi: 10.1016/j.annonc.2023.11.016.
8. Клинические рекомендации. Рак молочной железы. 2021.
9. Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet. 1998;351(9114):1451–67.
10. Pan H., Gray R., Braybrooke J., et al. 20-Year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377:1836–46.
11. Braunstein L.Z., Taghian A.G., Niemierko A., et al. Breast-cancer subtype, age, and lymph node status as predictors of local recurrence following breast-conserving therapy. Breast Cancer Res Treat. 2017;161(1):173–79. Doi: 10.1007/s10549-016-4031-5.
12. Stuart-Harris R., Dahlstrom J.E., Gupta R., et al. Recurrence in early breast cancer: Analysis of data from 3,765 Australian women treated between 1997 and 2015. Breast. 2019;44:153–59. Doi: 10.1016/j.breast.2019.02.004.
13. Zambelli A., Gallerani E., Garrone O., et al. Working tables on Hormone Receptor positive (HR+), Human Epidermal growth factor Receptor 2 negative (HER2-) early stage breast cancer: Defining high risk of recurrence. Crit Rev Oncol Hematol. 2023;191:104104. Doi: 10.1016/j.critrevonc.2023.104104.
14. Ding N.H., Liu C.F., Hu C., et al. Prognostic Factors for Luminal B-like Breast Cancer. Curr. Med. Sci. 2019;39(3):396–402. Doi: 10.1007/s11596-019-2049-8.
15. Kim S.W., Chun M., Han S., et al. Young Age Is Associated with Increased Locoregional Recurrence in Node-Positive Breast Cancer with Luminal Subtypes. Cancer Res Treat. 2017;49(2):484–93. Doi: 10.4143/crt.2016.246.
16. Fredholm H., Magnusson K., Lindstrom L.S., et al. Long-term outcome in young women with breast cancer: a population-based study. Breast Cancer Res Treat. 2016;160(1):131–43. Doi: 10.1007/s10549-016-3983-9.
17. Sparano J.A., Gray R.J., Makower D.F., et al. Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med. 2018;379:111–21.
18. Cardoso F., van’t Veer L.J., Bogaerts J., et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med. 2016;375:717–29.
19. Gray R., Bradley R., Braybrooke J., et al. Effects of ovarian ablation or suppression on breast cancer recurrence and survival: Patient-level meta-analysis of 14,993 pre-menopausal women in 25 randomized trials. J Clin Oncol. 2023;41:503–3. Doi: 10.1200/JCO.2023.41.16_suppl.503.
20. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet. 2015;386(10001):1341–52.
21. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials. Lancet Oncol. 2022;23(3):382–92. doi: 10.1016/S1470-2045(21)00758-0.
22. Davies C., Pan H., Godwin J., et al. Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16. Doi: 10.1016/S0140-6736(12)61963-1. Erratum in: Lancet. 2013;381(9869):804. Erratum in: Lancet. 2017;389(10082):1884.
23. Rastogi P., et al. Adjuvant Abemaciclib Plus Endocrine Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative, High-Risk Early Breast Cancer: Results From a Preplanned monarchE Overall Survival Interim Analysis, Including 5-Year Efficacy Outcomes. J Clin Oncol. 2024;42(9):987–93.
24. Fasching P. et al. LBA13 - Adjuvant ribociclib (RIB) plus nonsteroidal aromatase inhibitor (NSAI) in patients (Pts) with HR+/HER2- early breast cancer (EBC): 4-year outcomes from the NATALEE trial. Ann Oncol. 2024;35 (suppl_2): 1-72. Doi: 10.1016/annonc/annonc1623.
25. Francis P.A., Pagani O., Fleming G.F., et al. SOFT and TEXT Investigators and the International Breast Cancer Study Group. Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer. N Engl J Med. 2018;379(2):122–37. Doi: 10.1056/NEJMoa1803164.
26. Francis P.A., Fleming G.F., Lang I., et al. SOFT Investigators and the International Breast Cancer Study Group (a division of ETOP IBCSG Partners Foundation). Adjuvant Endocrine Therapy in Premenopausal Breast Cancer: 12-Year Results From SOFT. J Clin Oncol. 2023;41(7):1370–5. Doi: 10.1200/JCO.22.01065. [Epub 2022 Dec 9, Erratum in: J Clin Oncol. 2023;41(25):4187.
27. Pagani O., Walley B.A., Fleming G.F., et al. SOFT and TEXT Investigators and the International Breast Cancer Study Group (a division of ETOP IBCSG Partners Foundation). Adjuvant Exemestane With Ovarian Suppression in Premenopausal Breast Cancer: Long-Term Follow-Up of the Combined TEXT and SOFT Trials. J Clin Oncol. 2023;41(7):1376–82. Doi: 10.1200/JCO.22.01064.
28. Cuzick J., Sestak I., Baum M., et al. ATAC/LATTE investigators. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet. Oncol. 2010;11(12):1135–41. Doi: 10.1016/S1470-2045(10)70257-6.
29. Ruhstaller T., Giobbie-Hurder A., Colleoni M., et al.; members of the BIG 1-98 Collaborative Group and the International Breast Cancer Study Group. Adjuvant Letrozole and Tamoxifen Alone or Sequentially for Postmenopausal Women With Hormone Receptor-Positive Breast Cancer: Long-Term Follow-Up of the BIG 1-98 Trial. J. Clin. Oncol. 2019;37(2):105–14. Doi: 10.1200/JCO.18.00440.
30. Del Mastro L., Mansutti M., Bisagni G., et al: Extended therapy with letrozole as adjuvant treatment of postmenopausal patients with early-stage breast cancer: A multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021 September 17 (early release on-line).
31. Tjan-Heijnen V.C.G., van Hellemond I.E.G., Peer P.G.M., et al: Extended adjuvant aromatase inhibition after sequential endocrine therapy (DATA): A randomised, phase 3 trial. Lancet. Oncol 2017;18:1502–11.
32. Mamounas E.P., Bandos H., Lembersky B.C., et al: Ten-year results from NRG Oncology/NSABP B-42: A randomized, double-blinded, placebo-controlled clinical trial of extended adjuvant endocrine therapy with letrozole in postmenopausal women with hormone-receptor+ breast cancer who have completed previous adjuvant therapy with an aromatase inhibitor. 2019 San Antonio Breast Cancer Symposium. Abstract GS4-01. Presented 2019 December, 12.
33. Blok E.J., Kroep J.R., Meershoek-Klein Kranenbarg E., et al: Optimal duration of extended adjuvant endocrine therapy for early breast cancer: Results of the IDEAL trial (BOOG 2006-05). J Natl Cancer Inst. 2018;110(1).
34. Gnant M., Fitzal F., Rinnerthaler G., et al.; Austrian Breast and Colorectal Cancer Study Group. Duration of Adjuvant Aromatase-Inhibitor Therapy in Postmenopausal Breast Cancer. N Engl. J Med. 2021;385(5):395–405. Doi: 10.1056/NEJMoa2104162.
35. Freedman R.A., Caswell-Jin J.L., Hassett M., et al. Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer Guideline Expert Panel. Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer-Cyclin-Dependent Kinase 4 and 6 Inhibitors: ASCO Guideline Rapid Recommendation Update. J Clin Oncol. 2024:JCO2400886. Doi: 10.1200/JCO.24.00886.
36. Золотой стандарт профилактики, диагностики, лечения и реабилитации больных РМЖ. Российское общество онкомаммологов. 2024. URL: http://www.breastcancersociety.ru
Об авторах / Для корреспонденции
Автор для связи: Ольга Олеговна Гордеева, к.м.н., врач-онколог, химиотерапевт, заведующая дневным стационаром, Федеральный научно-клинический центр физико-химической медицины им. акад. Ю.М. Лопухина, Москва, Россия; Gordeeva.oo@yandex.ru; ORCID: https://orcid.org/0000-0002-8266-0218
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