Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Breast Cancer Res Treat. 2013 Jan;137(2):523-31. doi: 10.1007/s10549-012-2336-6. Epub 2012 Nov 27.
Adjuvant hormonal therapy for hormone receptor (HR)-positive primary breast cancer patients and a human epidermal growth factor receptor 2 (HER2)-targeted agent for HER2-positive primary breast cancer patients are standard treatment. However, it is not well known whether adding hormonal therapy to the combination of preoperative or postoperative chemotherapy and HER2-targeted agent contributes any additional clinical benefit in patients with HR-positive/HER2-positive primary breast cancer regardless of cross-talk between HR and HER2. We retrospectively reviewed records from 897 patients with HR-positive/HER2-positive primary breast cancer with clinical stage I-III disease who underwent surgery between 1988 and 2009. We determined the overall survival (OS) and disease-free survival (DFS) rates according to whether they received hormonal therapy or not and according to the type of hormonal therapy, tamoxifen and aromatase inhibitor, they received. The median followup time was 52.8 months (range 1-294.6 months). Patients who received hormonal therapy with chemotherapy and trastuzumab (n = 128) had significantly higher OS and DFS rates than did those who received only chemotherapy and trastuzumab (n = 46) in log-rank analysis (OS 96.1 vs. 87.0 %, p = 0.023, DFS 86.7 vs. 78.3 %, p = 0.029). There was no statistical difference in OS or DFS between those given an aromatase inhibitor and those given tamoxifen. In multivariate analysis, receiving hormonal therapy in addition to the combination of chemotherapy and trastuzumab was the sole independent prognostic factor for DFS (hazard ratio 0.446; 95 % CI 0.200-0.992; p = 0.048), and there was a similar trend in OS. Our study supported that hormonal therapy, whether in the form of an aromatase inhibitor or tamoxifen, confers a survival benefit when added to chemotherapy and trastuzumab in patients with HR-positive/HER2-positive primary breast cancer. Adjuvant treatment without hormonal therapy is inferior for this patient population.
对于激素受体（HR）阳性的原发性乳腺癌患者和人表皮生长因子受体 2（HER2）阳性的原发性乳腺癌患者，辅助激素治疗和针对 HER2 的靶向药物治疗是标准治疗。然而，对于 HR 阳性/HER2 阳性的原发性乳腺癌患者，无论 HR 和 HER2 之间是否存在串扰，在术前或术后化疗和 HER2 靶向药物治疗的基础上联合激素治疗是否能带来额外的临床获益，目前还不是很清楚。我们回顾性分析了 1988 年至 2009 年间接受手术治疗的 897 例 HR 阳性/HER2 阳性的 I-III 期原发性乳腺癌患者的临床资料。我们根据是否接受激素治疗以及所接受的激素治疗类型（他莫昔芬和芳香化酶抑制剂），确定总生存（OS）和无病生存（DFS）率。中位随访时间为 52.8 个月（范围 1-294.6 个月）。接受化疗和曲妥珠单抗联合激素治疗的患者（n = 128）的 OS 和 DFS 率明显高于仅接受化疗和曲妥珠单抗治疗的患者（n = 46）（OS：96.1% vs. 87.0%，p = 0.023；DFS：86.7% vs. 78.3%，p = 0.029）。接受芳香化酶抑制剂和他莫昔芬的患者在 OS 或 DFS 方面没有统计学差异。多因素分析显示，在接受化疗和曲妥珠单抗联合治疗的基础上，加用激素治疗是 DFS 的唯一独立预后因素（风险比 0.446；95%CI 0.200-0.992；p = 0.048），OS 也有类似的趋势。我们的研究支持在 HR 阳性/HER2 阳性的原发性乳腺癌患者中，激素治疗（无论是芳香化酶抑制剂还是他莫昔芬）与化疗和曲妥珠单抗联合应用可带来生存获益。对于该患者人群，不进行激素辅助治疗的预后较差。
