Advances in Systemic Treatment of Breast Cancer
Cet article passe en revue les avancées dans le traitement systémique de divers sous-types de cancer du sein (RH+/HER2-, HER2+ et triple négatif), notamment l'autorisation de mise sur le marché des agents ciblés ou l'extension de leurs indications, l'amélioration des résultats thérapeutiques grâce aux conjugués anticorps-médicaments et à l'immunothérapie, ainsi que le recours croissant au profilage moléculaire
Systemic therapy for breast cancer has evolved rapidly since 2020, driven by the expansion of targeted therapies, antibody–drug conjugates, and immunotherapy across biologic subtypes. The integration of tumor molecular profiling and germline testing has enabled increasingly personalized, biomarker-guided treatment strategies. In hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative disease, cyclin-dependent kinase 4 and 6 inhibitors remain foundational, whereas phosphatidylinositol 3-kinase pathway inhibitors, oral selective estrogen-receptor degraders, and antibody–drug conjugates have transformed disease management after endocrine resistance. In HER2-positive disease, antibody–drug conjugates — particularly trastuzumab deruxtecan — have improved outcomes and are being used in earlier lines of therapy, a development that is reshaping treatment paradigms. In triple-negative breast cancer, immune checkpoint inhibitors have improved outcomes in both metastatic and early-stage disease. Across subtypes, advances in curative therapy increasingly emphasize risk-adapted escalation and de-escalation of treatment. Ongoing challenges include improving treatment sequencing, identifying predictive biomarkers, integrating emerging tools such as analysis of circulating tumor DNA, and ensuring equitable access to high-cost therapies. This review summarizes advances in therapy, including approval or expanded use of targeted agents, improved outcomes with antibody–drug conjugates and immunotherapy, and growing reliance on molecular profiling.
New England Journal of Medicine , résumé, 2026