ABSTRACT
@# The efficacy and prognosis of human epidermal growth factor receptor 2 (HER2) positive breast cancer patients have been significantly improved with the development and wide application of anti-tumor drugs against HER2. The results of PEONY research once again established the status of the double-target treatment mode of pertuzumab+trastuzumab in the field of neoadjuvant therapy. Based on the two studies of TRYPHAENA and TRAIN-2, paclitaxel plus platinum should be the first choice chemotherapy scheme for anti HER2 double-target therapy, and the treatment course of 6 cycles is preferred. According to the consensus of neoadjuvant therapy experts in China and the latest follow-up results of adjuvant APT study, the neoadjuvant therapy is more suitable for patients with a tumor diameter of more than 3 cm and/or positive lymph nodes metastasis; T-DM1 should be the first choice of adjuvant therapy in patients, who didn’t obtain pCR after neoadjuvant treatment, and whether the double-target adjuvant mode of pertuzumab plus trastuzumab is suitable depends on follow-up of the PEONY study. Low-risk patients with small tumors (<3 cm) and without lymph node metastasis may consider omitting neoadjuvant therapy but adopt direct surgery followed by postoperative adjuvant therapy with trastuzumab plus paclitaxel. The regimen of trastuzumab+pertuzumab combined with taxanes is still the standard first line treatment of late stage HER2+ patients; for Chinese patients, pyrotinib combined with capecitabine can be used as the second line optimization, and T-DM1 can be used as the third line and posterior line selection; when trastuzumab, pertuzumab and T-DM1 fail the treatment, DS-8201 becomes a new selection mode. Combined treatment mode of tucatinib plus trastuzumab and capecitabine can be considered in late stage HER2+ patients with brain metastases.
ABSTRACT
@#人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）阳性乳腺癌侵袭性高，预后差。随着抗HER2 药物的不断出现及广泛应用，HER2阳性乳腺癌患者的预后出现了非常显著的改善。10年随访结果证实1年曲妥珠单抗辅助治 疗可以显著降低疾病复发风险；对于术后的高危人群，曲妥珠单抗联合帕妥珠单抗或者曲妥珠单抗序贯来那替尼可以进一步减 少复发。5年随访结果表明帕妥珠单抗+曲妥珠单抗为基础的新辅助治疗可使病理完全缓解（pathological complete response， pCR）转化为长期生存获益；白蛋白紫杉醇代替普通紫杉醇与抗HER2药物联用可以进一步提高pCR率；而抗HER2药物联合内 分泌治疗尚不能达到与联合化疗在新辅助治疗中疗效，即使联合CDK4/6抑制剂，对于pCR的提高依然有限。曲妥珠单抗+帕妥 珠单抗联合紫杉类药物是晚期HER2阳性乳腺癌的标准一线方案；对于老年、体弱的患者，节拍环磷酰胺可以作为紫杉类药物的 替代品；拉帕替尼+曲妥珠单抗联合内分泌治疗可以作为HER2阳性伴激素受体阳性的选择，疗效优于曲妥珠单抗联合内分泌治 疗；T-DM1无论是作为二线治疗还是三线及以后的治疗均提高了患者生存获益，是治疗晚期、耐药HER2阳性乳腺癌的首选。
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of primary squamous cell carcinoma of the breast and to improve the diagnosis, treatment and prognosis of this disease.</p><p><b>METHODS</b>The clinicopathological data of 22 patients with primary squamous cell carcinoma of the breast treated in our hospital between January 1985 and January 2011 were retrospectively reviewed. The correlation between age, tumor size, axillary node status, treatment modality and prognosis was statistically analyzed.</p><p><b>RESULTS</b>All the 22 patients were female and their median age was 56 years.The average tumor diameter was 3.6 cm.The diagnosis was confirmed by histopathology. The positive rates of expression of ER, PR and HER-2 of the breast cancers were 9. 1%, 9. 1% and 33. 3%, respectively. In follow-up visits, recurrence or metastasis was found in 5 patients and they all died of it. The median overall survival of the 22 patients was 60 months and their overall 5-year survival rate was 73.6%. Univariate analysis showed that the tumor maximum diameter (P = 0.024) and axillary lymph node status (P = 0.022) were impact factors, while menopause, chemotherapy and radiotherapy were not. Cox multivariate analysis showed that the tumor size (P = 0.021) and axillary lymph node status (P = 0.037) were independent prognostic factors for primary squamous cell carcinoma of the breast.</p><p><b>CONCLUSIONS</b>Primary squamous cell carcinoma of the breast is a rare entity and lack of specific clinical features. Axillary node status is an independent prognostic factor.</p>