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乳がん の 治療: 概要
Adrienne G Waks1, Eric P Winer1
1Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
JAMA
|January 23, 2019
まとめ
このレビューは,ホルモン受容体陽性,ERBB2陽性,トリプルネガティブの3つの主なサブタイプに焦点を当てた乳がん治療戦略を詳細に述べています. 最適な治療の選択は,腫瘍のサブタイプ,ステージ,患者の好みによって改善される.
科学分野:
- 腫瘍学
- 医学 遺伝学
- ガン 治療
背景:
- 乳がんは米国女性の12%に 影響し 毎年25万人以上の新規症例が報告されています
- ホルモン受容体陽性,ERBB2陽性,トリプルネガティブの3つの主要な分子サブタイプに分類される.
- ほとんどの乳がんは転移していない段階で診断され,再発のリスクはサブタイプによって異なります.
研究 の 目的:
- 乳がんの局所的および全身的治療のための現在のアプローチと進化する戦略をレビューする.
- 異なる乳がんサブタイプの特徴と治療パラダイムを強調する.
- 分子マーカー,ステージ,患者要因に基づく 個別化された治療の重要性を強調する.
主な方法:
- エストロゲン受容体,プロゲステロン受容体,ERBB2 (HER2) ステータスに基づく乳がんの分類.
- 各サブタイプに合わせた全身療法 (内分泌療法,化学療法,ERBB2標的療法) の記述
- 外科的切除と放射線治療を含む局所療法の概要と,新補助的全身療法の新たな役割.
主要な成果:
- ホルモン受容体陽性 (70%) とERBB2陽性 (15-20%) のサブタイプは,一般的にトリプルネガティブ (15%) の乳がんよりも予後が良い.
- 治療戦略は大きく異なる:ホルモン陽性では内分泌療法,ERBB2陽性では化学免疫療法,三重陰性では化学療法のみ.
- 転移性疾患の治療は命を延ばし,症状を緩和することを目的とし,生存率はサブタイプによって異なります.
結論:
- 乳がんには3つの異なる分子サブタイプがあり 独特のリスクプロファイルと治療戦略があります
- 最適な治療は,腫瘍のサブタイプ,癌のステージ,そして個々の患者の好みを考慮して個別化されます.
- ネオアジュバント療法や 反応に基づく治療の調整など 進化する戦略は 乳がんの管理を向上させています
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