循环肿瘤细胞与 HER2 阳性乳腺癌脑转移结局：LANDSCAPE 试验
Circulating tumor cells and brain metastasis outcome in patients with HER2-positive breast cancer: the LANDSCAPE trial.
机构信息
Department of Medical Oncology, Institut Curie and Université Paris Descartes, Paris.
出版信息
Ann Oncol. 2013 Dec;24(12):2999-3004. doi: 10.1093/annonc/mdt348. Epub 2013 Sep 6.
BACKGROUND
Decrease of circulating tumor cells (CTC) during treatment is an independent prognostic factor in metastatic breast cancer (MBC). We specifically evaluated the impact of CTC on brain metastasis outcome.
METHODS
HER2-positive MBC with brain metastasis not previously treated with whole-brain radiotherapy received first-line combination of lapatinib and capecitabine in a phase II study. CTC were detected at baseline and day 21 (CellSearch).
RESULTS
Median follow-up of the 44 analyzed patients was 21.2 months. The central nervous system objective response (CNS-OR) rate was 66%. At baseline, 20 of 41 assessable patients for CTC (49%) had ≥1 CTC (range 1-301, median 3) and 9 (22%) had ≥5 CTC. At day 21, 7 of 38 patients (18%) had ≥1 CTC (P = 0.006, versus baseline), and CTC had disappeared in 11 patients. CNS-OR rate was significantly higher in patients with no CTC at day 21 [25 of 31 (80%) versus 2 of 7 (29%), P = 0.01]. The 1-year overall survival rate was 83.9% in patients with no CTC at day 21 versus 42.9% in patients with ≥1 CTC (P = 0.02).
CONCLUSIONS
This is the first report showing a correlation between CNS metastasis response, outcome and early CTC clearance under targeted treatment of HER2+ MBC.
CLINICAL TRIALS NUMBER
NCT00967031.
背景
循环肿瘤细胞 (CTC) 在治疗过程中的减少是转移性乳腺癌 (MBC) 的一个独立预后因素。我们专门评估了 CTC 对脑转移结局的影响。
方法
HER2 阳性伴脑转移且既往未接受全脑放疗的 MBC 患者接受拉帕替尼联合卡培他滨的一线治疗。在一项 II 期研究中，在基线和第 21 天（CellSearch）检测 CTC。
结果
44 例可分析患者的中位随访时间为 21.2 个月。中枢神经系统客观缓解率（CNS-OR）为 66%。基线时，41 例可评估 CTC 的患者中有 20 例（49%）存在≥1 个 CTC（范围 1-301，中位数 3），9 例（22%）存在≥5 个 CTC。第 21 天，38 例患者中有 7 例（18%）存在≥1 个 CTC（P = 0.006，与基线相比），11 例 CTC 消失。第 21 天无 CTC 的患者 CNS-OR 率显著更高[25 例（80%）与 7 例（29%），P = 0.01]。第 21 天无 CTC 的患者 1 年总生存率为 83.9%，而存在≥1 个 CTC 的患者为 42.9%（P = 0.02）。
结论
这是第一项表明 HER2+MBC 靶向治疗下中枢神经系统转移反应、结局与早期 CTC 清除之间存在相关性的报告。
临床试验编号
NCT00967031。
Zotero 插件