HER2阳性转移性乳腺癌二线以上抗HER2疗法：临床方案综述与推荐

　　2016年4月，瑞士巴塞尔《Breast Care》正式发表西班牙专家小组关于HER2阳性转移性乳腺癌二线以上抗HER2疗法的临床方案综述与推荐。

　　在推荐方案1中，西班牙专家小组根据EGF104900研究中期分析（PMID：20124187）和最终分析（PMID：22689807）认为曲妥珠单抗＋拉帕替尼能够改善术后辅助或转移治疗后疾病进展患者的总生存，当无法获得T-DM1时可以考虑。

　　在推荐方案4中，西班牙专家小组根据日本研究（PMID：23011099）、美国研究（PMID：25015089）和2014年《晚期HER2阳性乳腺癌和脑转移患者疾病管理推荐：美国临床肿瘤学会临床实践指南》认为对于抗HER2治疗后脑转移进展，拉帕替尼＋卡培他滨似乎是最佳局部治疗后的好选择。

Breast Care (Basel). 2016 Apr;11(2):133-8.

Anti-HER2 Therapy Beyond Second-Line for HER2-Positive Metastatic Breast Cancer: A Short Review and Recommendations for Several Clinical Scenarios from a Spanish Expert Panel.

Martínez-Janez N, Chacón I, de Juan A, Cruz-Merino L, Del Barco S, Fernández I, García-Teijido P, Gómez-Bernal A, Plazaola A, Ponce J, Servitja S, Zamora P.

Hospital Ramón y Cajal, Madrid, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Universitario Doctor Josep Trueta, Gerona, Spain; Hospital Xeral Cies de Vigo, Pontevedra, Spain; Hospital de Avilés, Asturias, Spain; Hospital Clínico de Salamanca, Salamanca, Spain; Onkologikoa, San Sebastián, Spain; Hospital General Universitario de Alicante, Alicante, Spain; Hospital del Mar, Barcelona, Spain; Hospital la Paz, Madrid, Spain.

BACKGROUND: The aim of this project was to provide an expert opinion regarding anti-human epidermal growth factor receptor 2 (HER2) therapy beyond second-line treatment of metastatic breast cancer (mBC).

METHODS: A group of experts discussed specific issues concerning anti-HER2 therapy in late-line settings in mBC.

RESULTS: Trastuzumab emtansine (T-DM1) or dual HER2 blockade appeared to be good options for HER2-positive mBC after ≥ 2 HER2-targeted therapies. Once an objective response has been achieved with anti-HER2-containing therapy, the anti-HER2 agent can be continued until progression of the disease, unacceptable toxicity or patient decision. mBC treated with ≥ 3 consecutive lines of anti-HER therapy, ≥ 1 being a dual HER2 blockade and with early progression of disease during a fourth or later-line treatment, are clinically resistant to anti-HER therapy. For progression of metastasis in the brain after anti-HER2 therapy, lapatinib and chemotherapy appear to be a good alternative after best local treatment.

CONCLUSIONS: Further clinical trials are needed to provide valuable knowledge about the best treatment options in the later settings of mBC.

KEYWORDS: Anti-HER2; Clinical practice; Metastatic breast cancer

PMID: 27239176

DOI: 10.1159/000443601