内容紹介
Progress in Second-Line Therapies for Metastatic Breast Cancer
Summary
It may be difficult to achieve complete cure for most metastatic breast cancer patients; thus, prolongation of overall survival and maintenance of the quality of life are often the main focus of treatment. In the treatment of metastatic breast cancer patients, it is important to choose the most appropriate therapeutic strategy based on substantial evidence that considers the biology of the tumor, including estrogen receptor(ER), progesterone receptor(PgR), and human epidermal growth factor receptor 2(HER2)status; the site and extent of the metastatic focus; the time to recurrence; prior treatment regimens; age; menopausal status; performance status; and the preference of the patient. A clinical subtype classification that is based on the tumor biology is typically utilized for devising a treatment strategy specific to each subtype. Expressly, first-line treatment options may include hormone therapy for hormone-positive breast cancers, antiHER2 therapy for HER2-positive breast cancers, and chemotherapy for hormone-negative and HER2-negative(triple negative)breast cancers. In recent years, with the development of regimens that are effective for every subtype, the treatments for breast cancer have undergone significant changes. In this section, we introduce the progress in the treatment for metastatic breast cancer, focusing specifically on second-line therapies according to each subtype.
要旨 転移再発乳癌において限られた症例を除いて治癒は困難であり,生存期間(overall survival: OS)の延長と質の高いquality of life(QOL)の維持が治療の目的となる。転移再発乳癌に対しては腫瘍の生物学的特性,転移巣の場所(臓器)とその広がり,再発までの期間,前治療の内容とその効果,年齢,閉経状況,performance status(PS),患者の希望・価値観などを考慮し,これまで構築されてきたエビデンスを基に最適な薬物療法を選択することが重要である。転移再発乳癌に対しては薬物療法が主体となるが,薬物療法開始前にエストロゲン受容体(estrogen receptor: ER),プロゲステロン受容体(progesterone receptor: PgR)といったホルモン受容体とヒト上皮成長因子受容体2(human epidermal growth factor receptor 2: HER2)の発現状況を評価し,それらを基にサブタイプ分類を行う。現在,臨床に応用されているサブタイプ分類としてLuminalタイプ(ER陽性またはPgR陽性),HER2タイプ(HER2陽性),トリプルネガティブタイプ(ER陰性かつPgR陰性かつHER2陰性)があり,近年,サブタイプごとに有効なレジメンが開発され乳癌に対する薬物療法は大きな変遷を遂げている。本稿では転移再発乳癌に対する薬物療法の進歩をsecond-line therapyを中心にサブタイプ別に紹介する。
目次
Summary
It may be difficult to achieve complete cure for most metastatic breast cancer patients; thus, prolongation of overall survival and maintenance of the quality of life are often the main focus of treatment. In the treatment of metastatic breast cancer patients, it is important to choose the most appropriate therapeutic strategy based on substantial evidence that considers the biology of the tumor, including estrogen receptor(ER), progesterone receptor(PgR), and human epidermal growth factor receptor 2(HER2)status; the site and extent of the metastatic focus; the time to recurrence; prior treatment regimens; age; menopausal status; performance status; and the preference of the patient. A clinical subtype classification that is based on the tumor biology is typically utilized for devising a treatment strategy specific to each subtype. Expressly, first-line treatment options may include hormone therapy for hormone-positive breast cancers, antiHER2 therapy for HER2-positive breast cancers, and chemotherapy for hormone-negative and HER2-negative(triple negative)breast cancers. In recent years, with the development of regimens that are effective for every subtype, the treatments for breast cancer have undergone significant changes. In this section, we introduce the progress in the treatment for metastatic breast cancer, focusing specifically on second-line therapies according to each subtype.
要旨 転移再発乳癌において限られた症例を除いて治癒は困難であり,生存期間(overall survival: OS)の延長と質の高いquality of life(QOL)の維持が治療の目的となる。転移再発乳癌に対しては腫瘍の生物学的特性,転移巣の場所(臓器)とその広がり,再発までの期間,前治療の内容とその効果,年齢,閉経状況,performance status(PS),患者の希望・価値観などを考慮し,これまで構築されてきたエビデンスを基に最適な薬物療法を選択することが重要である。転移再発乳癌に対しては薬物療法が主体となるが,薬物療法開始前にエストロゲン受容体(estrogen receptor: ER),プロゲステロン受容体(progesterone receptor: PgR)といったホルモン受容体とヒト上皮成長因子受容体2(human epidermal growth factor receptor 2: HER2)の発現状況を評価し,それらを基にサブタイプ分類を行う。現在,臨床に応用されているサブタイプ分類としてLuminalタイプ(ER陽性またはPgR陽性),HER2タイプ(HER2陽性),トリプルネガティブタイプ(ER陰性かつPgR陰性かつHER2陰性)があり,近年,サブタイプごとに有効なレジメンが開発され乳癌に対する薬物療法は大きな変遷を遂げている。本稿では転移再発乳癌に対する薬物療法の進歩をsecond-line therapyを中心にサブタイプ別に紹介する。