Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA.
Cancer. 2010 Sep 15;116(18):4227-37. doi: 10.1002/cncr.25309.
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.
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.
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).
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.
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。
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）。
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）。
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。
