CDK4/6抑制剂联合内分泌治疗乳腺癌的破局和困局  

The breakthrough and dilemma of CDK4/6 inhibitors in combination with endocrine therapy

作　　者：叶松青[1] YE Songqing(Department of oncology surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院肿瘤外科,福建福州350001

出　　处：《中国肿瘤外科杂志》2023年第4期404-409,共6页Chinese Journal of Surgical Oncology

摘　　要：乳腺癌是全球女性最常见的恶性肿瘤,也是导致女性死亡的主要原因之一。仅2022年,中国约有34.1万的乳腺癌新发病例,呈逐年快速增长趋势。据统计,激素受体阳性/人类表皮生长因子受体-2阴性乳腺癌约占所有乳腺癌的70%。内分泌治疗是该类乳腺癌治疗的基石,其联合CDK4/6抑制剂的治疗方案已得到国内外专家的一致共识,成为激素受体阳性/人类表皮生长因子受体-2阴性乳腺癌的标准治疗。截止目前国内已上市的CDK4/6抑制剂包括达尔西利、哌柏西利、瑞波西利和阿贝西利。对于激素受体阳性/人类表皮生长因子受体-2阴性局部晚期和转移性乳腺癌,CDK4/6抑制剂联合芳香化酶抑制剂或氟维司群一线或二线及以上治疗均可大幅度降低疾病进展或死亡风险,奠定了CDK4/6抑制剂在晚期一线或后线治疗地位。在早期辅助治疗阶段,阿贝西利、瑞波西利已显示出显著延长患者iDFS及OS疗效,而需要接受新辅助治疗、内脏危象及CDK4/6抑制剂经治等患者研究目前仍在探索之中。该文系统性介绍CDK4/6抑制剂的药理学特征及临床研究进展,总结CDK4/6抑制剂联合内分泌治疗的破局和困局。Breast cancer is the most common malignant tumor in women and one of the leading causes of death in women worldwide.In China,there will be about 341,000 new cases of breast cancer in 2022,which is still on a fast rising trend.HR+/HER2-breast cancer accounts for approximately 70%of all breast cancers.Endocrine therapy is the cornerstone of the treatment of this type of breast cancer,and its combined treatment with cyclin dependent kinase 4/6 inhibitor(CDK4/6i)has been unanimously agreed by experts at home and abroad,becoming the standard treatment for HR+/HER2-breast cancer.Currently marketed CDK4/6 inhibitors Dalpiciclib,Palbociclib,Ribociclib and Abemaciclib.For HR+/HER2-locally advanced and metastatic breast cancer,CDK4/6i combined with aromatase inhibitors or Fulvestrant first-line or second-line and above treatment significantly reduced the risk of disease progression or death,and established the position of CDK4/6i in advanced first-line or postline treatment.Abemaciclib and Ribociclib have been shown to significantly prolong the efficacy of iDFS and OS in patients at the early stage of adjuvant therapy,while studies in patients with neoadjuvant therapy,visceral crisis,and CDK4/6 inhibitor therapy are still being explored.This paper systematically introduces the pharmacological characteristics and clinical research progress of CDK4/6i,and summarizes the breakdown and difficulties of CDK4/6i combined with endocrine therapy.

关 键 词：乳腺肿瘤 CDK4/6抑制剂 雌激素受体 孕激素受体 人表皮生长因子受体-2 

分 类 号：R737.9[医药卫生—肿瘤]