臨床外科76巻2号

2021年02月発行

特集 外科医のための—悪性腫瘍補助療法のすべて 各論

乳癌の術前術後補助療法

著者： 山田美紀¹ 神野浩光¹

所属機関： ¹帝京大学医学部外科学講座

ページ範囲：P.227 - P.232

【ポイント】
◆乳癌の初期治療では臨床病理学的因子の情報をもとに，根治をめざして局所療法と全身療法を組み合わせた集学的治療を行う．
◆薬物療法として化学療法，内分泌療法，分子標的薬があり，サブタイプを考慮して治療を選択する．
◆手術を先行したとしても化学療法が必要と思われる症例では術前化学療法を行う．病理学的完全奏効（pCR）が予後因子となる場合がある．また，pCRを指標に術後治療を組み立てるレスポンスガイド治療について研究が行われている．

参考文献

1）国立がん研究センターがん情報サービス：がん登録・統計〔http://ganjoho.jp/reg_stat/statistics/dl/index.html〕

2）Early Breast Cancer Trialists' Collaborative Group（EBCTCG）：Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen：patient-level meta-analysis of randomized trials. Lancet 378：771-784, 2011

3）Goss PE, Ingle JN, Martino S, et al：Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer：updated findings from NCIC CTG MA.17. J Natl Cancer Inst 97：1262-1271, 2005

4）Adjuvant Tamoxifen Longer Against Shorter（ATLAS）Collaborative Group, Davies C, Pan H, Godwin J, et al：Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer：ATLAS, a randomized trial. Lancet 381：805-816, 2013

5）Francis PA, Pagani O, Fleming GF；for the SOFT and TEXT Investigators and the International Breast Cancer Study Group：Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer. N Engl J Med 379：122-137, 2018

6）Early Breast Cancer Trialists' Collaborative Group（EBCTCG）：Aromatase inhibitors versus tamoxifen in early breast cancer：patient-level meta-analysis of the randomized trials. Lancet 386：1341-1352, 2015

7）Goss PE, Ingle JN, Pritchard KI, et al：Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375：209-219, 2016

8）Allred DC, Anderson SJ, Paik S, et al：Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ：a study based on NSABP protocol B-24. J Clin Oncol 30：1268-1273, 2012

9）Cuzick J, Sestak I, Baum M, et al：ATAC/LATTE investigators：Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer：10-year analysis of the ATAC trial. Lancet Oncol 11：1135-1141, 2010

10）Mouridsen H, Giobbie-Hurder A, Goldhirsch A, et al；BIG 1-98 Collaborative Group：Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med 361：766-776, 2009

11）van de Velde CJ, Rea D, Seynaeve C, et al：Adjuvant tamoxifen and exemestane in early breast cancer（TEAM）：a randomised phase 3 trial. Lancet 377：321-331, 2011

12）Mamounas EP, Jeong JH, Wickerham DL, et al：Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen：intention-to-treat analysis of the National Surgical Adjuvant Breast And Bowel Project B-33 trial. J Clin Oncol 26：1965-1971, 2008

13）NCCN Guidelines Version 5. 2020浸潤性乳癌〔https://www2.tri-kobe.org/nccn/guideline/breast/japanese/breast.pdf〕

14）Sparano JA, Gray RJ, Makower DF, et al：Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med. 379：111-121, 2018

15）Early Breast Cancer Trialists' Collaborative Group：Polychemotherapy for early breast cancer：an overview of the randomized trials. Lancet 352：930-942, 1998

16）Early Breast Cancer Trialists' Collaborative Group（EBCTCG）：Comparisons between different polychemotherapy regimens for early breast cancer：meta-analyses of long-term outcome among 100,000 women in 123 randomized trials. Lancet 379：432-444, 2012

17）Jones S, Holmes FA, O'Shaughnessy J, et al：Docetaxel with cyclophosphamide is associated with an overall survival benefit compared with doxorubicin and cyclophosphamide：7-year follow-up of US Oncology research trial 9735. J Clin Oncol 27：1177-1183, 2009

18）Citron ML, Berry DA, Cirrincione C, et al：Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer：first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21：1431-1439, 2003

19）Moja L, Tagliabue L, Balduzzi S, et al：Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev 2012：CD006243, 2012

20）Slamon D, Eiermann W, Robert NJ, et al：Ten year follow-up of BCIRG-006 comparing doxorubicin plus cyclophosphamide followed by docetaxel（AC→T）with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab（AC→TH）with docetaxel, carboplatin and trastuzumab（TCH）in HER2＋early breast cancer. SABCS, S5-04, 2015

21）von Minckwitz G, Procter M, de Azambuja E, et al, APHINITY Steering Committee and Investigators：Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med 377：122-131, 2017

22）Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al, Herceptin Adjuvant（HERA）Trial Study Team：Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353：1659-1672, 2005

23）Perez EA, Romond EH, Suman VJ, et al：Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer：joint analysis of data from NCCTG N9831 and NSABP B-31. J Clin Oncol 29：3366-3373, 2011

24）Sara M, Hao G, Sonia P et al：Seven-year follow-up analysis of adjuvant paclitaxel and trastuzumab trial for node-negative, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol 37：1868-1875, 2019

25）Norman W, Jiping W, Eleftherios M, et al：Preoperative chemotherapy in patients with operable breast cancer：nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 30：96-102, 2001

26）Rastogi P, Anderson SJ, Bear HD, et al：Preoperative chemotherapy：updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 26：778-785, 2008

27）Gianni L, Pienkowski T, Im YH, et al：Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer（NeoSphere）：a randomized multicenter, open-label, phase 2 trial. Lancet Oncol 13：25-32, 2012

28）Gianni L, Eiermann W, Semiglazov V, et al：Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer（NOAH）：follow-up of a randomized controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol 15：640-647, 2014

29）Semiglazov VF, Semiglazov VV, Dashyan GA, et al：Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer 110：244-254, 2007

30）Masuda N, Lee SJ, Ohtani S, et al：Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med 376：2147-2159, 2017

31）von Minckwitz G, Huang CS, Mano MS, et al, KATHERINE Investigators：Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med 380：617-628, 2019

32）von Minckwitz G, Blohmer JU, Costa SD, et al：Response-guided neoadjuvant chemotherapy for breast cancer. J Clin Oncol 31：3623-3630, 2013