Hirano Akira, Shimizu Tadao, Kamimura Mari, Ogura Kaoru, Kim Naomi, Setoguchi Yumika, Okubo Fumie, Kinoshita Jun, Ogawa Kenji, Fujibayashi Mariko
Dept. of Breast Surgery, Tokyo Women 's Medical University Medical Center East.
Gan To Kagaku Ryoho. 2011 May;38(5):771-6.
The aim of this study was to investigate responses to primary systemic therapy (PST) for breast cancer, by hormone receptor (HR) and HER2 status. This study included 107 women with T>3 cm and/or node-positive breast cancer who received PST at this department between March 2004 and January 2009. Treatment with epirubicin and cyclophosphamide (EC) followed by docetaxel (DTX) therapy was undertaken up to December 2005. From January 2006, EC followed by weekly paclitaxel (PTX) with or without trastuzumab (T) therapy was performed. From February 2008 and thereafter, the EC-PTX-T therapy was continued in HER2-positive patients, whereas the preceding EC-DTX therapy was administered in HER2-negative patients. Clinical responses of the 107 patients (56 were treated with EC-DTX, 37 with EC-PTX, and 14 with EC-PTX-T) were as follows: CR was achieved in 18 patients, PR in 74 patients, SD in 12 patients, and PD in 3 patients, with a response rate of 86. 0%. Histologically, 14 patients(13. 2%)had pathological CR(pCR)in a limited sense. When these patients were further divided according to HR status, those positive for both estrogen receptor (ER) and progesterone receptor (PgR) accounted for 1. 8%, those positive for ER and negative for PgR accounted for 5. 3%, and those negative for both ER and PgR accounted for a significantly higher percentage of 40. 0% (p<0. 0001) . By HER2 status, pCR was achieved at a significantly higher rate (47. 8%) of HER2-positive patients, compared to 3. 6% of HER2-negative patients (p<0. 0001). Common adverse events included Grade 3/4 leukopenia (57. 9%), neutropenia (67. 3%), and Grade 3 febrile neutropenia (11. 2%). The results show that a higher pCR rate can be expected after PST in HR-negative patients and HER2-positive patients. HER2-positive patients would particularly benefit from preoperative anthracycline chemotherapy followed by a taxane combined with trastuzumab.
本研究旨在按激素受体（HR）和HER2状态，调查乳腺癌患者对原发性全身治疗（PST）的反应。本研究纳入了107例T>3 cm和/或淋巴结阳性的乳腺癌女性患者，这些患者于2004年3月至2009年1月在本科室接受了PST。在2005年12月之前采用表柔比星和环磷酰胺（EC）治疗，随后进行多西他赛（DTX）治疗。从2006年1月起，采用EC治疗，随后给予每周一次的紫杉醇（PTX），联合或不联合曲妥珠单抗（T）治疗。从2008年2月及以后，HER2阳性患者继续采用EC-PTX-T治疗，而HER2阴性患者则采用之前的EC-DTX治疗。107例患者的临床反应（56例接受EC-DTX治疗，37例接受EC-PTX治疗，14例接受EC-PTX-T治疗）如下：18例患者达到完全缓解（CR），74例患者达到部分缓解（PR），12例患者疾病稳定（SD），3例患者疾病进展（PD），缓解率为86.0%。组织学上，14例患者（13.2%）在有限意义上达到病理完全缓解（pCR）。当根据HR状态进一步划分这些患者时，雌激素受体（ER）和孕激素受体（PgR）均阳性的患者占1.8%，ER阳性而PgR阴性的患者占5.3%，而ER和PgR均阴性的患者占比显著更高，为40.0%（p<0.0001）。按HER2状态划分，HER2阳性患者的pCR率显著更高（47.8%），而HER2阴性患者为3.6%（p<0.0001）。常见不良事件包括3/4级白细胞减少（57.9%）、中性粒细胞减少（67.3%）和3级发热性中性粒细胞减少（11.2%）。结果表明，HR阴性和HER2阳性患者在接受PST后有望获得更高的pCR率。HER2阳性患者尤其会从术前蒽环类化疗后联合紫杉烷及曲妥珠单抗治疗中获益。
