协和医学杂志

2019, v.10(04) 414-418

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无心脏基础疾病的老年HER-2阳性乳腺癌患者是否应行曲妥珠单克隆抗体治疗?
Whether Elderly Patients with Her-2 Positive Breast Cancer but Without Heart Disease Should Receive Targeted Therapy?

徐颖;林燕;王常珺;赵佳琳;孙强;
XU Ying;LIN Yan;WANG Chang-jun;ZHAO Jia-lin;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

随着我国人口老龄化,乳腺癌治疗需要面对更多的老年患者。近年来,靶向治疗作为人表皮生长因子受体2 (human epidermal growth factor receptor 2,HER-2)阳性乳腺癌全身治疗的重要方法,在乳腺癌治疗中的地位越来越重要。无心脏基础疾病的老年HER-2阳性乳腺癌患者是否应使用曲妥珠单克隆抗体进行靶向治疗存在争议。目前证据表明,60~70岁老年HER-2阳性乳腺癌患者可从曲妥珠单克隆抗体治疗中获益,心脏事件风险较低且可逆,但70岁以上患者目前无大规模试验证据支持。在选择辅助治疗方案时需平衡获益与风险,综合考虑患者本人意愿和身体状况,进行个体化治疗。若治疗选择曲妥珠单克隆抗体,需避免与蒽环类化疗药物联用并监测心功能,及时发现和处理心脏事件。
With a nationwide increase in elderly population,an increased number of breast cancer diagnosed in older women is expected. Nowadays,targeted therapy is an important systemic treatment for human epidermal growth factor 2( HER-2) positive breast cancer,which has been playing an important role in the treatment for breast cancer. It is controversial whether trastuzumab should be used for targeted therapy in elderly Her-2 positive breast cancer patients with moderate risk and no cardiac disease. Current evidence suggests that patients aged 60-70 years old with a moderate risk of Her-2 positive breast cancer may benefit from trastuzumab with an acceptable and reversible risk of heart events. Yet there is no enough evidence for elderly patients beyond 70 years old. Therefore,we should balance the benefit and risk when considering targeted therapy for elderly patients with breast cancer. Management of breast cancer in the elderly should take the will of the patients,the physical condition,and comorbidities in to consideration. Anthracycline-based chemotherapy should not be used together with targeted therapy. It is necessary to monitor cardiac function and deal with heart events timely.

关键词(KeyWords): 老年;乳腺癌;靶向治疗
old women;breast cancer;targeted therapy

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作者(Author): 徐颖;林燕;王常珺;赵佳琳;孙强;
XU Ying;LIN Yan;WANG Chang-jun;ZHAO Jia-lin;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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