Peintinger F, Buzdar A U, Kuerer H M, Mejia J A, Hatzis C, Gonzalez-Angulo A M, Pusztai L, Esteva F J, Dawood S S, Green M C, Hortobagyi G N, Symmans W F
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
Ann Oncol. 2008 Dec;19(12):2020-5. doi: 10.1093/annonc/mdn427. Epub 2008 Jul 29.
The aim of this study was to compare the extent of pathologic response in patients with HER2-positive (HER2+) breast cancer treated with standard neoadjuvant chemotherapy, with or without trastuzumab (H), according to hormone receptor (HR) status.
We included 199 patients with HER2+ breast cancer from three successive cohorts of neo-adjuvant chemotherapy on the basis of paclitaxel (Taxol) (P) administered weekly (w) or three weekly (3-w), followed by 5-fluorouracil (F), doxorubicin (A) or epirubicin (E), and cyclophosphamide (C). Residual cancer burden (RCB) was determined from pathologic review of the primary tumor and lymph nodes and was classified as pathologic complete response (pCR) or minimal (RCB-I), moderate (RCB-II), or extensive (RCB-III) residual disease.
In HR-positive (HR+) cancers, a higher rate of pathologic response (pCR/RCB-I) was observed with concurrent H + 3-wP/FEC (73%) than with 3-wP/FEC (34%, P = 0.002) or wP/FAC (47%; P = 0.02) chemotherapy alone. In HR-negative (HR-) cancers, there were no significant differences in the rate of pathologic response (pCR/RCB-I) from 3-wP/FAC (50%), wP/FAC (68%), or concurrent H + 3-wP/FEC (72%).
Patients with HR+/HER2+ breast cancer obtained significant benefit from addition of trastuzumab to P/FEC chemotherapy; pathologic response rate was similar to that seen in HR-/HER2+ breast cancers.
本研究的目的是根据激素受体（HR）状态，比较接受标准新辅助化疗（含或不含曲妥珠单抗（H））的HER2阳性（HER2+）乳腺癌患者的病理反应程度。
我们纳入了199例HER2+乳腺癌患者，这些患者来自三个连续的新辅助化疗队列，化疗方案基于每周（w）或每三周（3-w）给予紫杉醇（泰素）（P），随后给予5-氟尿嘧啶（F）、多柔比星（A）或表柔比星（E）以及环磷酰胺（C）。通过对原发肿瘤和淋巴结的病理检查确定残余癌负担（RCB），并将其分类为病理完全缓解（pCR）或微小（RCB-I）、中度（RCB-II）或广泛（RCB-III）残留疾病。
在HR阳性（HR+）癌症中，同时使用H + 3-wP/FEC时观察到的病理反应率（pCR/RCB-I）（73%）高于单独使用3-wP/FEC（34%，P = 0.002）或wP/FAC（47%；P = 0.02）化疗。在HR阴性（HR-）癌症中，3-wP/FAC（50%）、wP/FAC（68%）或同时使用H + 3-wP/FEC（72%）的病理反应率（pCR/RCB-I）无显著差异。
HR+/HER2+乳腺癌患者在P/FEC化疗中添加曲妥珠单抗可获得显著益处；病理反应率与HR-/HER2+乳腺癌相似。
