HER-2阳性早期乳腺癌有无必要行辅助化疗？

　　HER-2阳性乳腺癌的标准治疗是抗HER-2治疗作为辅助疗法，以及抗HER-2治疗早期乳腺癌。对于肿瘤>1 cm的患者，抗HER-2疗法联合化疗获得了一致推荐。肿瘤<1cm的患者采取个性化治疗，但数据显示，一些HER-2阳性、肿瘤很小（特别是肿瘤激素受体阴性）的患者的治疗结果较差，因此这类患者仍然考虑增加化疗联合曲妥珠单抗治疗。最近的一项试验结果表明，采取以上疗法治疗肿瘤<3cm（一半肿瘤<1cm）的患者，其3年无病生存期获益为98%。

　　欲使抗HER-2治疗安全且有效，需要找出获益最多的患者

　　通常采取抗HER-2疗法联合化疗治疗HER-2阳性患者，但是某些患者可能获益很少。要达到最佳治疗效果，需要找出抗HER-2治疗获益最多的患者：患者选取标准是抗HER-2治疗获益（比如降低患者复发风险）、抗HER-2治疗的耐受性。患有6~7mm肿瘤、激素受体阴性的年轻患者考虑抗HER-2治疗，因其未来的人生还很长，抗HER-2治疗确实有助于防止复发；但是对于患有6 mm肿瘤的高龄患者则不建议抗HER-2治疗。

　　一线治疗后患者病情缓解，其抗癌治疗停止要逐步进行

　　患者一线治疗后病情缓解或病情稳定，何时停止乳腺癌治疗？对于抗HER-2治疗起效的转移性乳腺癌，其抗癌治疗停止是逐步进行的，先停止部分癌症疗法-化疗，但是通常继续抗HER-2治疗，治疗时间不确定，医生会定期检查患者以确认其能否获益于所用抗HER-2药物。

　　最新版NCCN乳腺癌指南对HER-2阳性乳腺癌的治疗推荐

　　NCCN指南明确推荐，HER-2阳性乳腺癌采取抗HER-2治疗。但并非建议抗HER-2治疗肿瘤非常小的患者，只是建议淋巴结阴性、肿瘤<1 cm的患者也要考虑抗HER-2疗法，激素受体阴性的患者更要如此。肿瘤> 1cm的患者应以抗HER-2疗法作为标准治疗以改善治疗结果。

访谈原文

　　Oncology Frontier: Is adjuvant chemotherapy necessary for patients with HER2-positive early breast cancer?

　　《肿瘤瞭望》： HER-2阳性早期乳腺癌有无必要行辅助化疗？

　　Dr Gradishar: The standard of care for patients with HER2-positive breast cancer is to receive anti-HER2 therapy in the adjuvant setting and the early stage breast cancer setting. We uniformly recommend that anti-HER2 therapy be combined with chemotherapy for patients with tumors >1cm. For patients with tumors <1cm in size， we individualize. There is data suggesting that some of those patients， particularly those with hormone receptor-negative disease， may have some worse outcomes. So in those populations where the tumors are very small， we would still consider adding chemotherapy and trastuzumab. The results of a recent trial showed that when we do that， patients with tumors <3cm in size (half of those being tumors <1cm in size)， disease free survival at three years was 98%.

　　Gradishar医生：HER-2阳性乳腺癌的标准治疗是抗HER-2辅助疗法，以及抗HER-2治疗早期乳腺癌。我们一致推荐肿瘤>1 cm的患者抗HER-2治疗联合化疗。肿瘤<1cm的患者采取个性化治疗，但数据显示，一些HER-2阳性、肿瘤很小（特别是肿瘤激素受体阴性）的患者的治疗结果较差，因此这类患者仍然考虑增加化疗和曲妥珠单抗治疗。最近的一项试验结果表明，采取以上疗法治疗肿瘤<3cm（一半肿瘤<1cm）的患者，其3年无病生存期获益为98%。

　　Oncology Frontier:How do you choose between safe treatment and effective treatment for HER2-positive breast cancer?

　　《肿瘤瞭望》：对于HER-2阳性乳腺癌，您如何权衡治疗的安全性和有效性？

　　Dr Gradishar: We try to make decisions about who are the best candidates for anti-HER2 therapy based on what they will benefit most from (which includes reducing the risk of disease coming back) and we also take into account whether they can tolerate therapy. Anti-HER2 therapy is typically combined with chemotherapy， so there may be patients who derive very little benefit. In other words， someone who has a 3-4 mm tumor may be treated very differently than a young patient， who has a 6-7mm， hormone receptor-negative， whom I would consider HER2 therapy for because they have many years ahead of them and we may indeed be able to stop recurrence. On the other hand， I am not going to give anti-HER2 therapy to an 80-year old with a 6mm tumor.

　　Gradishar医生：要达到最佳治疗效果，需要找出抗HER-2治疗获益最多的患者：患者选取标准是抗HER-2治疗获益（比如降低患者复发风险）、患者能否耐受治疗。抗HER-2治疗通常联合化疗，有些患者可能获益很少，某些 3~4 mm肿瘤的治疗很困难。患有6~7mm肿瘤、激素受体阴性的年轻患者考虑抗HER-2治疗，因为他们未来的人生还很长，抗HER-2治疗确实有助于防止复发；但是对于患有6 mm肿瘤的80岁患者，我则不会予以抗HER-2治疗。