University of Wisconsin Carbone Cancer Center, Wisconsin Institutes for Medical Research, 6th floor, 1111 Highland Avenue, Madison, WI, USA.
Breast Cancer Res Treat. 2012 Jan;131(2):713-21. doi: 10.1007/s10549-011-1862-y. Epub 2011 Nov 8.
Multiple adjuvant regimens are used for HER2+ breast cancer, but experience in routine practice is not reported. We evaluated whether oncologists' perceptions of these regimens matches clinical experience. We surveyed Wisconsin medical oncologists throughout the state regarding factors impacting selection of TCH (docetaxel, carboplatin, and trastuzumab) or anthracycline-based therapy. We also reviewed 200 cases of HER2+ breast cancer treated at the University of Wisconsin and the Marshfield Clinic and collected data on patient and tumor characteristics, chemotherapy regimen, and toxicities. Two-thirds of surveyed oncologists prefer anthracycline-based therapy, particularly for node-positive cancers. However, TCH was preferred for early-stage (T1a-bN0) tumors. Half of oncologists use prophylactic G-CSF with TCH. In the 200 cases reviewed at our centers, acute toxicity occurred more frequently with TCH. There were fewer dose modifications or delays for AC-TH (doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab) than TCH (31% vs. 47%, P = 0.07), possibly due to higher use of prophylactic G-CSF with AC-TH (77% vs. 34% with TCH, P < 0.001). Fifteen patients received prophylactic G-CSF during TCH; none developed neutropenic fever. In contrast, 25% developed neutropenic fever during TCH without G-CSF. There were modest declines in median left ventricular ejection fraction reaching 9% with AC-TH and 3% with TCH at 12 months, but early cessation of trastuzumab was similar for both regimens. We conclude that TCH and AC-TH are common adjuvant regimens used for HER2+ breast cancer. The preference of TCH for early-stage disease and anthracycline-based therapy for node-positive disease suggests that many oncologists perceive that TCH is safer and AC-TH more effective. Myelosuppression from TCH is greater than AC-TH, but can be mitigated with routine G-CSF.
针对 HER2+ 乳腺癌，有多种辅助治疗方案，但目前尚缺乏常规实践经验。我们评估了肿瘤学家对这些方案的看法是否与临床经验相符。我们对威斯康星州的医学肿瘤学家进行了调查，内容涉及影响选择 TCH（多西他赛、卡铂和曲妥珠单抗）或蒽环类药物治疗的因素。我们还回顾了在威斯康星大学和马什菲尔德诊所治疗的 200 例 HER2+ 乳腺癌患者的病例，并收集了患者和肿瘤特征、化疗方案和毒性等数据。三分之二的调查肿瘤学家更喜欢蒽环类药物治疗，尤其是对于淋巴结阳性的癌症。然而，TCH 则更适合早期（T1a-bN0）肿瘤。半数肿瘤学家使用预防性 G-CSF 联合 TCH。在我们中心回顾的 200 例病例中，TCH 更常出现急性毒性。与 TCH 相比，AC-TH（多柔比星、环磷酰胺、紫杉醇和曲妥珠单抗）的剂量调整或延迟更少（31%对 47%，P=0.07），这可能是因为 AC-TH 更常预防性使用 G-CSF（77%对 34%，P<0.001）。15 例患者在 TCH 治疗期间接受了预防性 G-CSF，无中性粒细胞减少性发热发生。相比之下，未使用 G-CSF 的 25%的患者在 TCH 治疗期间出现中性粒细胞减少性发热。AC-TH 治疗后 12 个月时左心室射血分数中位数略有下降，达到 9%，而 TCH 治疗后下降 3%，但两种方案中早期停用曲妥珠单抗的比例相似。我们的结论是，TCH 和 AC-TH 是用于 HER2+ 乳腺癌的常见辅助治疗方案。TCH 适用于早期疾病，蒽环类药物治疗适用于淋巴结阳性疾病，这表明许多肿瘤学家认为 TCH 更安全，AC-TH 更有效。TCH 的骨髓抑制作用大于 AC-TH，但常规使用 G-CSF 可减轻其影响。
