世界各地的研究人员正在努力寻找预防,检测和治疗乳腺癌的更好方法,并改善患者和幸存者的生活质量。
乳腺癌病友群,扫码加群
与乳腺癌发生相关的原因
持续的科学研究,包括运动、生活方式、习惯以及遗传基因对乳腺癌的风险。
- 体重增加或减少以及饮食的影响。
- 关于乳腺癌基因突变的检测。
- 基因的微小变化和综合影响如何影响乳腺癌风险
- 导致乳腺癌的环境。
降低患乳腺癌的风险
- 阻断雌激素的药物通常用于帮助治疗乳腺癌,但有些也可能有助于预防乳腺癌。他莫昔芬和雷洛昔芬已被用于预防乳腺癌多年。最近对另一类称为芳香酶抑制剂(依西美坦和阿那曲唑)的药物研究表明,这些药物在预防乳腺癌方面也非常有效
- 其他临床试验正在研究减少乳腺癌的非激素类药物。药物包括用于糖尿病的药物(如二甲双胍),用于治疗血液或骨髓疾病的药物(如ruxolitinib)和贝沙罗汀(一种治疗特定类型T细胞淋巴瘤的药物)。
这种类型的研究需要很多年。关于这些化合物的有意义的结果可能尚待一段时间。
液体活检
循环肿瘤细胞(CTC)和循环肿瘤DNA(ctDNA)
一些研究表明,在转移性(第4阶段)乳腺癌女性中,高水平的CTC可能比低水平的女性预后更差。
- 寻找新的基因变化(突变),这可能意味着肿瘤细胞已对特定治疗产生抗性(如芳香酶抑制剂)
- 在尝试某种药物之前先确定它是否对肿瘤有效
- 通过检测CTC指标下降来帮助确定女性癌症患者是否对某种疗法有反应
- 预测患有早期乳腺癌的女性是否会复发
新的成像测试
- 核素成像(分子乳房成像)
- 正电子放射乳腺摄影(PEM乳腺癌早期诊断扫描仪)
- 电阻抗成像(EIT)
- 弹性成像
- 新型光学成像测试
乳腺癌治疗
众所周知,化疗可以帮助许多乳腺癌患者。但是,预测个体化疗的获益高低仍处于研究当中。有时化疗会产生明显的副作用(长期和短期),能够确定谁真正需要化疗的会很有价值。许多研究正在评估不同的测试,可以更准确地判断哪些患者将从化疗中受益,哪些患者可以避免使用。
三阴性乳腺癌
由于三阴性乳腺癌(TNBC)无法通过激素疗法或靶向疗法(例如HER2药物)进行治疗,因此治疗选择仅限于化学疗法。虽然TNBC倾向于对初始化疗反应良好,但与其他乳腺癌相比,往往复发的更频繁。2019年,免疫治疗药物Atezolizumab(Tecentriq)与化疗药物紫杉醇(Abraxane)联合用于进展的三阴性乳腺癌女性,PD-L1。近年来,已经确定了新的乳腺癌药物潜在靶标。基于这些目标靶点的药物,例如激酶抑制剂,单独或与化疗联合治疗三阴性乳腺癌。一个例子是AKT抑制剂ipatasertib,当与紫杉醇一起使用时,在TNBC作为一线治疗效果显著。另一种AKT抑制剂capivasertib,与紫杉醇联合使用时,也显示出令人鼓舞的结果。
雄激素受体抑制剂
乳腺癌通常检测雌激素和孕激素受体,以帮助确定治疗方案。大约60%的乳腺癌细胞也具有雄激素(雄性激素)受体。初步研究表明,使用抗雄激素比卡鲁胺治疗的乳腺癌女性,具有雄激素受体的三阴乳腺癌患者会产生一些反应。比卡鲁胺是一种已经用于治疗前列腺癌多年的药物。乳腺癌方面的更多研究正在进行中。支持性护理
有试验观察不同的药物来改善化疗后的记忆力和脑部症状。也有研究正在评估某些心脏药物(也被称为β受体阻滞剂),是否可以预防常见乳腺癌药物(如阿霉素和曲妥珠单抗)治疗引起的心脏损害。关于参加临床试验的思考
参考文献:
American Joint Committee on Cancer. Breast. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:589.
Cristofanilli M, Pierga JY, Reuben J, Rademaker A, Davis AA, Peeters DJ et al. The clinical use of circulating tumor cells (CTCs) enumeration for staging of metastatic breast cancer (MBC): International expert consensus paper. Crit Rev Oncol Hematol. 2019 Feb;134:39-45.
Cuzick, J et al. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. The Lancet. 2014;383 (9922):1041 - 1048.
Goss, P.E., et al., Exemestane for Breast-Cancer Prevention in Postmenopausal Women. New England Journal of Medicine, 2011. 364(25): p. 2381-2391.
Greene LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci. 2015;62(1):54-65.
Henry NL, Bedard PL, and DeMichele A. Standard and Genomic Tools for Decision Support in Breast Cancer Treatment. In Dizon DS, Pennel N, Rugo HS, Pickell LF, eds. 2017 American Society of Clinical Oncology Educational Book. 53rd Annual Meeting. 2017.
Ignatiadis M, Lee M, and Jeffrey SS. Circulating Tumor Cells and Circulating Tumor DNA: Challenges and Opportunities on the Path to Clinical Utility. Clin Cancer Res; 21(21); 4786–800.
Jhan JR, Andrechek ER. Triple-negative breast cancer and the potential for targeted therapy. Pharmacogenomics. 2017;18(17):1595–1609. doi:10.2217/pgs-2017-0117.
Litton JK, Burstein HJ, Turner NC. Molecular Testing in Breast Cancer. Am Soc Clin Oncol Educ Book. 2019 Jan;39:e1-e7. doi: 10.1200/EDBK_237715. Epub 2019 May 17.
Mayer IA, Dent R, Tan T, et al. Novel Targeted Agents and Immunotherapy in Breast Cancer. In Dizon DS, Pennel N, Rugo HS, Pickell LF, eds. 2017 American Society of Clinical Oncology Educational Book. 53rd Annual Meeting. 2017.
National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search. Bexarotene in Preventing Breast Cancer in Patients at High Risk for Breast Cancer. Accessed August 15, 2019.
National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search. Donepezil Hydrochloride in Improving Memory Performance in Breast Cancer Survivors after Chemotherapy. Accessed August 15, 2019.
National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search. Metformin Hydrochloride in Preventing Breast Cancer in Patients with Atypical Hyperplasia or In Situ Breast Cancer. Accessed August 15, 2019.
National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search. Ruxolitinib in Preventing Breast Cancer in Patients with High Risk and Precancerous Breast Lesions. Accessed August 15, 2019.
National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search. Testing the Addition of a Blood Pressure Medication, Carvedilol, to HER-2 Targeted Therapy for Metastatic Breast Cancer to Prevent Cardiac Toxicity. Accessed August 15, 2019.
Rossi G, Mu Z, Rademaker AW, Austin LK, Strickland KS, Costa RLB et al. Cell-Free DNA and Circulating Tumor Cells: Comprehensive Liquid Biopsy Analysis in Advanced Breast Cancer. Clin Cancer Res. 2018 Feb 1;24(3):560-568.
Savard MF, Khan O, Hunt KK, Verma S. Redrawing the Lines: The Next Generation of Treatment in Metastatic Breast Cancer. Am Soc Clin Oncol Educ Book. 2019 Jan;39:e8-e21.
Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2013;105:701-710.
Yu M, Bardia A, Aceto N et al. Ex vivo culture of circulating breast tumor cells for individualized testing of drug susceptibility. Science. 2014 Jul 11; 345(6193): 216–220.
Last Revised: September 18, 2019
发表评论 取消回复