2016年12月30日,欧洲肿瘤内科学会官方期刊、牛津大学出版社旗下《肿瘤学年鉴》在线发表葡萄牙尚帕利莫临床中心、德国慕尼黑大学、巴西南里奥格兰德天主教大学、瑞典卡罗林斯卡医学院、西班牙拉蒙卡哈尔大学医院、西班牙瓦尔德西布伦肿瘤学研究所、黎巴嫩贝鲁特美国大学医学中心、澳大利亚墨尔本大学圣文森特医院彼得麦卡勒姆癌症中心、美国临床肿瘤学会首席执行官、日本癌症研究会医院、美国达纳法伯癌症研究所、美国斯坦福大学、英国皇家马斯登医院、加拿大不列颠哥伦比亚癌症中心的述评,总结了乳腺癌的临床研究需求与建议行动。 乳腺癌是女性最常见的恶性肿瘤之一,约占女性癌症患者的25%,仅次于肺癌成为发达国家肿瘤患者的第二大死因。尽管乳腺癌的发病率逐年增加,但是随着癌症早期筛查和辅助治疗方案的完善,欧美等高收入国家乳腺癌患者的死亡率得到了有效控制。 数据显示,癌症早期筛查推广约降低了20%乳腺癌死亡率。此外,乳腺癌也是肿瘤领域分子机制研究较为领先的学科,基础研究在过去15年极大促进了乳腺癌治疗发展并改善了患者预后,例如靶向HER2阳性乳腺癌的曲妥珠单抗、用于内分泌治疗的芳香酶抑制剂。 尽管乳腺癌患者的治疗和预后有所改善,但仍有很多问题亟待解决,例如治疗耐药、复发等。此外,发展中国家乳腺癌的发病率和死亡率激增,这也是值得关注的问题。 本文根据2016年乳腺癌专家组的议案,总结了12个乳腺癌临床治疗所面临的问题,旨在聚焦乳腺癌研究热点、加速治疗研究进程: 一、不影响结局前提下的早期乳腺癌降级治疗策略
二、优化辅助治疗的持续时间
三、开发可筛选具有遗传易感性患者的工具和策略
四、改善年轻乳腺癌患者的治疗方案
五、加速针对具有特定生物标志物人群的药物研发
六、寻找可以解决化疗、内分泌治疗或抗HER2治疗耐药的新型药物
七、评估转移性乳腺癌患者局部区域治疗的疗效
八、优化转移性乳腺癌患者不同治疗方案的顺序
玖、评估患者异质性(肿瘤内、肿瘤间、不同病灶间的异质性)对临床治疗的影响
十、深化三阴性乳腺癌生物学理解,开发新药物
十一、了解乳腺癌免疫监视机制并进一步发展免疫治疗
十二、推进癌症生存者生存研究,提供支持治疗,改善生活质量
结论 这些由肿瘤学专家提出的研究问题反映了近几年乳腺癌临床决策的变化,可见临床需求越来越趋向于控制转移性乳腺癌,制定个体化治疗方案和改善生活质量。上述12个问题为肿瘤领域的科研人员和临床医师提供了新方向,也为乳腺癌患者带来了新希望。 Ann Oncol. 2016 Dec 30. [Epub ahead of print] Research needs in breast cancer. Cardoso F, Harbeck N, Barrios CH, Bergh J, Cortés J, El Saghir N, Francis PA, Hudis CA, Ohno S, Partridge AH, Sledge GW, Smith IE, Gelmon KA. Champalimaud Clinical Centre, Lisbon, Portugal; University of Munich (LMU), Munich, Germany; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Karolinska Institutet and University Hospital, Stockholm, Sweden; Ramon y Cajal University Hospital, Madrid, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; American University of Beirut Medical Center, Beirut, Lebanon; Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia; Chief Executive Officer, American Society of Clinical Oncology, Alexandria, VA, USA; Cancer Institute Hospital, Koto-ku, Tokyo, Japan; Dana-Farber Cancer Institute, Boston, MA, USA; Stanford University, Stanford, CA, USA; Royal Marsden Hospital, London, United Kingdom; BC Cancer Agency, Vancouver, Canada. New research questions emerge as medical needs continue to evolve and as we improve our understanding of cancer biology and treatment of malignancies. Although significant advances have been made in some areas of breast cancer research resulting in improvements in therapies and outcomes over the last few decades, other areas have not benefited to the same degree and we continue to have many gaps in our knowledge. This article summarizes the 12 short and medium-term clinical research needs in breast cancer deemed as priorities in 2016 by a panel of experts, in an attempt to focus and accelerate future research in the most needed areas: 1) de-escalate breast cancer therapies in early breast cancer without sacrificing outcomes; 2) explore optimal adjuvant treatment durations; 3) develop better tools and strategies to identify patients with genetic predisposition; 4) improve care in young patients with breast cancer; 5) develop tools to speed up drug development in biomarker-defined populations; 6) identify and validate targets that mediate resistance to chemotherapy, endocrine therapy and anti-HER2 therapies; 7) evaluate the efficacy of local-regional treatments for metastatic disease; 8) better define the optimal sequence of treatments in the metastatic setting; 9) evaluate the clinical impact of intra-patient heterogeneity (intra-tumor, inter-tumor and inter-lesion heterogeneity); 10) better understand the biology and identify new targets in triple-negative breast cancer; 11) better understand immune surveillance in breast cancer and further develop immunotherapies; and 12) increase survivorship research efforts including supportive care and quality of life. PMID: 27831505 PII: mdw571 DOI: 10.1093/annonc/mdw571 |
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