Mayo Clinic, Jacksonville, Florida.
Stanford University, Stanford, California.
Cancer Immunol Res. 2014 Oct;2(10):962-9. doi: 10.1158/2326-6066.CIR-14-0059. Epub 2014 Jul 2.
Patients with HER2+ breast cancer treated with trastuzumab and chemotherapy have superior survival compared with patients treated with chemotherapy alone. Polymorphisms within FCGR2A and FCGR3A are associated with binding affinity of natural killer cells to the IgG1 portion of trastuzumab, and a polymorphism in FCGR2B (I232T) is associated with impaired regulatory activity. The association of these polymorphisms with clinical response among trastuzumab-treated patients is equivocal, with both positive and negative associations. We performed genotyping analysis on the FCGR3A V158F, FCGR2A R131H, and FCGR2B I232T polymorphisms in 1,325 patients from the N9831 clinical trial. Patients in arm A (N = 419) received chemotherapy only. Patients in arms B (N = 469) and C (N = 437) were treated with chemotherapy and trastuzumab (sequentially in arm B and concurrently in arm C). Using log-rank test and Cox proportional hazard models, we compared disease-free survival (DFS) among genotypic groups within pooled arms B/C. We found no differences in DFS between trastuzumab-treated patients who had the FCGR3A 158 V/V and/or FCGR2A 131 H/H high-affinity genotypes and patients without those genotypes. Furthermore, there was no significant interaction between FCGR3A and FCGR2A and treatment. However, there was a difference in DFS for FCGR2B I232T, with I/I patients deriving benefit from trastuzumab (P < 0.001), compared with the T carriers who did not (P = 0.81). The interaction between FCGR2B genotype and treatment was statistically significant (P = 0.03). Our analysis did not reveal an association between FcγR high-affinity genotypes and outcomes. However, it seems that the FCGR2B inhibitory gene may be predictive of adjuvant trastuzumab benefit.
接受曲妥珠单抗和化疗治疗的 HER2+乳腺癌患者的生存情况优于单独接受化疗的患者。FCGR2A 和 FCGR3A 内的多态性与自然杀伤细胞与曲妥珠单抗 IgG1 部分的结合亲和力有关,而 FCGR2B 中的一个多态性(I232T)与调节活性受损有关。这些多态性与曲妥珠单抗治疗患者的临床反应之间的关联尚无定论,既有正相关也有负相关。我们在 N9831 临床试验中的 1325 名患者中对 FCGR3A V158F、FCGR2A R131H 和 FCGR2B I232T 多态性进行了基因分型分析。A 臂(N = 419)的患者仅接受化疗。B 臂(N = 469)和 C 臂(N = 437)的患者接受化疗和曲妥珠单抗治疗(B 臂序贯治疗,C 臂同时治疗)。使用对数秩检验和 Cox 比例风险模型,我们比较了 pooled 臂 B/C 中不同基因型组之间的无病生存期(DFS)。我们发现,在具有 FCGR3A 158 V/V 和/或 FCGR2A 131 H/H 高亲和力基因型的曲妥珠单抗治疗患者与没有这些基因型的患者之间,DFS 没有差异。此外,FCGR3A 和 FCGR2A 与治疗之间没有显著的相互作用。然而,FCGR2B I232T 的 DFS 存在差异,I/I 患者从曲妥珠单抗治疗中获益(P < 0.001),而 T 携带者则没有(P = 0.81)。FCGR2B 基因型与治疗之间的相互作用具有统计学意义(P = 0.03)。我们的分析没有发现 FcγR 高亲和力基因型与结局之间的关联。然而,似乎 FCGR2B 抑制基因可能是预测曲妥珠单抗辅助治疗获益的标志物。
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