HER2阳性乳腺癌抗HER2治疗研究进展

Research Progress in Anti-HER2 Therapies for HER2-Positive Breast Cancer

摘要: 人表皮生长因子受体2 (human epidermal growth factor receptor 2, HER2)阳性乳腺癌恶性程度高、复发转移风险高，其临床治疗问题备受关注。抗HER2治疗体系不断更新，包括靶向治疗、传统化疗、细胞治疗等，靶向治疗药物研发加快、临床用药增多，抗体药物偶联物(antibody-drug conjugate, ADCs)开启治疗新阶段。本综述核心观点：曲妥珠 + 帕妥珠(HP)双靶仍是早期一线治疗方案，ADCs能够大幅提升晚期患者生存上限，小分子酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKIs)优先用于脑转移人群，化疗推行铂类降阶梯、减毒优化策略。本文系统梳理现有抗HER2治疗相关研究资料，剖析当前治疗局限，并展望未来研发方向，为临床个体化治疗决策提供循证参考。

Abstract: Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is characterized by high malignancy potential and elevated risks of tumor recurrence and distant metastasis, posing persistent challenges to clinical diagnosis and treatment. The systemic therapeutic regimen for HER2-targeted therapy has undergone continuous upgrading, covering targeted intervention, conventional chemotherapy, cellular immunotherapy and other modalities. With the accelerated research and development of targeted agents and the expanding scope of clinical application, antibody-drug conjugates (ADCs) have inaugurated an innovative stage for the comprehensive management of this disease. The core conclusions of this review are summarized as follows: the dual-target regimen combining trastuzumab and pertuzumab (HP) remains the first-line therapeutic backbone for early-stage HER2-positive breast cancer; ADCs substantially improve the long-term survival benefit of patients with advanced diseases; small-molecule tyrosine kinase inhibitors (TKIs) serve as the preferred therapeutic option for patients complicated with brain metastasis; and platinum de-escalation and toxicity reduction have become the core optimization principles of modern chemotherapy strategies. This study systematically consolidates the latest research findings on HER2-targeted therapies, analyzes the existing deficiencies and clinical limitations of current therapeutic regimens, and prospects the future development directions of novel drugs and therapeutic strategies, aiming to provide evidence-based references for individualized clinical treatment decision-making.