晚期雌激素受體陽性乳癌患者治療進展之綜論

Review of Advances in the Treatment of Advanced Estrogen-receptor-positive Breast Cancer

張嘉哲(Chia-Che Chang)

《內科學誌》 29卷6期 (2018/12) Pp. 381-392

https://doi.org/10.6314/JIMT.201812_29(6).05

摘要

荷爾蒙治療對於此亞型的乳癌具有重要性，然而在晚期乳癌中，仍不可避免會產生抗藥性。近期對治療雌激素受體陽性的乳癌患者有巨大的進展，特別是對荷爾蒙治療中所造成的抗藥性機轉。對於晚期乳癌患者，這巨大的進展提供了多種不同的標靶治療方式，進一步提升荷爾蒙治療的效果。特別是抑制mTOR及Cyclin-dependent kinase CDK4和CDK6具體提升了無進展生存期(progression-free survival)。新的標靶治療方式仍在研發中，其中包PI3K、AKT及HER2 和新一代雌激素受體降解劑(ER degraders)。雖然已有巨大的進展，可是對於晚期雌激素受體陽性乳癌患的治療，其選取何種病患、治療藥物的先後順序以及相互間的抗藥性，仍是一大挑戰。因此，文獻回顧目前此晚期乳癌的進展。

關鍵字

雌激素受體陽性乳癌(Estrogen-receptor positive breast cancer) ； 晚期乳癌(Advanced breast cancer)

並列摘要

Estrogen-receptor-positive breast cancer is the most common subtype of breast cancer. Endocrine therapies that target the dependence of this subtype on the estrogen receptor have substantial activity and the development of resistance to therapy is inevitable in advanced cancer. Major progress has been made in identifying the drivers of estrogen-receptor-positive breast cancer and the mechanisms of resistance to endocrine therapy. Inhibitors of mTOR and inhibitors of the cyclin-dependent kinases CDK4 and CDK6 substantially improve progression-free survival. New targeted therapies are being developed, including inhibitors of PI3K, AKT, and HER2, and a new generation of estrogen-receptor degraders. The challenges remain in patient selection, deciding on the most appropriate order in which to administer therapies, and establishing whether cross-resistance occurs between therapies. Thus, we review the current advanced treatment of breast cancer.