Servicio de Oncología Médica, Departmento de Oncología, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.
Breast Cancer Res Treat. 2010 Aug;123(1):149-57. doi: 10.1007/s10549-009-0663-z.
Treatment with fluororacil, epirubicin, and cyclophosphamide followed by weekly paclitaxel (FEC-P) yielded superior disease-free survival than FEC in the adjuvant breast cancer trial GEICAM 9906. We evaluate molecular subtypes predictive of prognosis and paclitaxel response in this trial. Two molecular subtype classifications based on conventional immunohistochemical and fluorescent in situ hybridization determinations were used: #1: Four groups segregated according to the combination of hormone receptor (HR) and HER2 status; #2: Intrinsic subtype classification (Triple Negative (TN), HER2, Luminal B and Luminal A).
Both subtype classifications yielded prognostic and predictive information. HR +/HER2- patients (and Luminal A patients) had a significantly better outcome than the other subgroups of patients. The superiority of FEC-P over FEC was clearly more marked in HR-/HER2- patients (TN patients), particularly in the subset with basal phenotype (TN and either EGFR+ or cytokeratins 5/6+). The Luminal A subtype also achieved a significant benefit with FEC-P. The molecular-defined subgroup of TN was clearly predictive of better response to treatment with FEC-P. Luminal A patients had the best prognosis and also have a better outcome with weekly paclitaxel.
氟尿嘧啶、表柔比星和环磷酰胺联合治疗后每周紫杉醇（FEC-P）在辅助乳腺癌试验 GEICAM 9906 中比 FEC 更能提高无病生存率。我们在这项试验中评估了预测预后和紫杉醇反应的分子亚型。使用了两种基于常规免疫组织化学和荧光原位杂交测定的分子亚型分类：#1：根据激素受体（HR）和 HER2 状态的组合，将四个组分开；#2：固有亚型分类（三阴性（TN）、HER2、Luminal B 和 Luminal A）。
两种亚型分类均提供了预后和预测信息。HR+/HER2- 患者（和 Luminal A 患者）的结局明显优于其他患者亚组。FEC-P 优于 FEC 的优势在 HR-/HER2- 患者（TN 患者）中更为明显，特别是在具有基底表型的亚组中（TN 患者，且 EGFR+或细胞角蛋白 5/6+）。Luminal A 亚型也从 FEC-P 治疗中获得了显著获益。分子定义的 TN 亚组对 FEC-P 治疗的反应更好具有明显的预测性。Luminal A 患者的预后最好，每周紫杉醇治疗的效果也更好。
