三阴性乳腺癌对多西他赛和卡铂为基础的新辅助治疗的差异性反应。
Differential response of triple-negative breast cancer to a docetaxel and carboplatin-based neoadjuvant treatment.
机构信息
Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA.
出版信息
Cancer. 2010 Sep 15;116(18):4227-37. doi: 10.1002/cncr.25309.
BACKGROUND
In this study, the authors evaluated whether a pathologic complete response (pCR) or a clinical complete response (cCR) to neoadjuvant treatment in patients with locally advanced breast cancer differed among the 3 subtypes of breast cancer: triple-negative breast cancer (TNBC), human epidermal growth factor receptor 2 (HER2)-positive breast cancer, and hormone receptor-positive/HER2-negative breast cancer. Whether a cCR or a pCR was correlated with fewer recurrences and better survival also was investigated.
METHODS
Patients with stage II/III breast cancer received 4 cycles of neoadjuvant docetaxel and carboplatin (TC) every 3 weeks. Patients with HER2-positive tumors were randomized to receive either additional weekly trastuzumab preoperatively or TC alone. Postoperatively, all patients received 4 cycles of TC, and all HER2-positive patients received a total of 52 weeks of trastuzumab. The recurrence-free survival (RFS) and overall survival (OS) rates at 2 years were reported.
RESULTS
Seventy-four patients were enrolled, including 11 patients with TNBC, 30 patients with HER2-positive tumors, and 33 patients with hormone receptor-positive/HER2-negative tumor. The cCR rates were 45.4%, 50% and 40.6% in TNBC, HER2-positive, and hormone receptor-positive/HER2-negative groups, respectively. The pCR rate for the entire group was 26.8%, and patients with TNBC had the best response (54.6%) followed by patients with HER2-positive tumors (24.1%) and patients with hormone receptor-positive/HER2-negative tumors (19.4%; P = .0126). The pCR rate for patients with HER2-positive tumors improved from 7% to 40% if trastuzumab was added (P = .08). Infiltrating ductal cancer, TNBC, negative estrogen receptor and/or progesterone receptor status, tumor classification predicted a pCR (P ≤ .05). Multivariate analysis using a logistic regression test indicated that tumor type was an independent predictor. The RFS rate for patients who did versus patients who did not achieve a pCR was 93.8% versus 78.4% at 2 years, respectively, and 83.3% versus 58% at 3 years, respectively (P = .1227); whereas, for patients who did versus patients who did not achieve a cCR, the RFS rate was 80.9% versus 83.9%, respectively, at 2 years and 65% versus 64.3%, respectively, at 3 years (P = .999).
CONCLUSIONS
The current results indicated that the TC combination is promising for the treatment of TNBC. The addition of trastuzumab to TC improved the pCR rate significantly in patients with HER2-positive breast cancer.
背景
在这项研究中，作者评估了局部晚期乳腺癌的 3 种亚型（三阴性乳腺癌[TNBC]、人表皮生长因子受体 2 [HER2]阳性乳腺癌和激素受体阳性/HER2 阴性乳腺癌）患者新辅助治疗的病理完全缓解（pCR）或临床完全缓解（cCR）是否存在差异。还研究了 cCR 或 pCR 是否与复发减少和生存改善相关。
方法
Ⅱ/Ⅲ期乳腺癌患者每 3 周接受 4 周期新辅助多西他赛和卡铂（TC）治疗。HER2 阳性肿瘤患者随机接受术前每周曲妥珠单抗或 TC 单独治疗。术后，所有患者均接受 4 周期 TC 治疗，所有 HER2 阳性患者均接受总计 52 周的曲妥珠单抗治疗。报告了 2 年时的无复发生存率（RFS）和总生存率（OS）。
结果
共纳入 74 例患者，包括 11 例 TNBC 患者、30 例 HER2 阳性肿瘤患者和 33 例激素受体阳性/HER2 阴性肿瘤患者。TNBC、HER2 阳性和激素受体阳性/HER2 阴性组的 cCR 率分别为 45.4%、50%和 40.6%。整个组的 pCR 率为 26.8%，TNBC 患者的反应最好（54.6%），其次是 HER2 阳性肿瘤患者（24.1%）和激素受体阳性/HER2 阴性肿瘤患者（19.4%；P=.0126）。如果添加曲妥珠单抗，HER2 阳性肿瘤患者的 pCR 率从 7%提高到 40%（P=.08）。浸润性导管癌、TNBC、雌激素受体和/或孕激素受体阴性、肿瘤分类预测 pCR（P≤.05）。使用逻辑回归检验的多变量分析表明，肿瘤类型是独立的预测因素。与未达到 pCR 的患者相比，达到 pCR 的患者的 2 年 RFS 率分别为 93.8%和 78.4%，3 年 RFS 率分别为 83.3%和 58%（P=.1227）；而与未达到 cCR 的患者相比，达到 cCR 的患者的 2 年 RFS 率分别为 80.9%和 83.9%，3 年 RFS 率分别为 65%和 64.3%（P=.999）。
结论
目前的结果表明，TC 联合治疗有望成为 TNBC 的治疗方法。在 HER2 阳性乳腺癌患者中添加曲妥珠单抗可显著提高 pCR 率。
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