Echavarria Isabel, Granja Mónica, Bueno Coralia, Lopez-Tarruella Sara, Peinado Paloma, Sotelo Miguel, Jerez Yolanda, Moreno Fernando, Torres Gabriela, Lobo Miriam, Marquez-Rodas Ivan, Del Monte-Millan Maria, Martín Miguel, García-Saenz Jose Angel
Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Hospital Clínico San Carlos, Madrid, Spain.
Breast Cancer Res Treat. 2017 Feb;162(1):181-189. doi: 10.1007/s10549-016-4098-z. Epub 2016 Dec 31.
In an era where neoadjuvant dual blockade is emerging as the standard of care for early and locally advanced HER2-positive breast cancer, we aimed to identify predictors of response to single-blockade chemotherapy.
This retrospective analysis reviewed all the incident stage I-III HER2-positive breast cancer patients who received neoadjuvant docetaxel, carboplatin, and trastuzumab (TCH) in three institutions. pCR was defined as the absence of invasive tumor in breast and axillary nodes (ypT0/isypN0).
From 2008 to 2015, 84 patients receiving neoadjuvant TCH were identified within our institutions. The mean age at diagnosis was 51.8 years. 59.5% of the patients were hormone receptor (HR) positive, lymph node involvement occurred in 67.9%, and clinical distribution was 2.4, 65.5, and 32.1% for stage I, II, and III, respectively. pCR rate was 47.6%; there was a significantly lower response in HR-positive patients compared to HR-negative ones (34 vs 67.6%, p = 0.005). pCR rate was associated with tumor size, whereas differences did not reach significance either for stage or for nodal status. Multivariate analysis found that only HR status was associated with response (p = 0.003). At a median follow-up of 31.7 months, disease-free survival, distant disease-free survival, and overall survival were 78.6, 85.7, and 94%, respectively. Breast-conserving surgery was performed in 44% of the patients. Overall, TCH was well tolerated, with low rates of grade 3-4 adverse events, and neither late toxicities nor cardiac dysfunctions were reported.
Neoadjuvant TCH, an anthracycline-free single-blockade regimen, achieved a pCR of 47.6%. Further molecular analyses are required in order to identify stronger predictive markers of pCR and thus for an accurate selection of patients who do not benefit from dual blockade.
在新辅助双阻断疗法正成为早期和局部晚期HER2阳性乳腺癌标准治疗方案的时代，我们旨在确定单阻断化疗反应的预测因素。
这项回顾性分析纳入了在三个机构接受新辅助多西他赛、卡铂和曲妥珠单抗（TCH）治疗的所有I-III期HER2阳性乳腺癌初诊患者。pCR定义为乳腺和腋窝淋巴结无浸润性肿瘤（ypT0/isypN0）。
2008年至2015年期间，在我们机构内共识别出84例接受新辅助TCH治疗的患者。诊断时的平均年龄为51.8岁。59.5%的患者激素受体（HR）阳性，67.9%的患者有淋巴结受累，I、II和III期的临床分布分别为2.4%、65.5%和32.1%。pCR率为47.6%；HR阳性患者的反应明显低于HR阴性患者（34%对67.6%，p = 0.005）。pCR率与肿瘤大小相关，而分期或淋巴结状态的差异未达到显著水平。多因素分析发现，只有HR状态与反应相关（p = 0.003）。中位随访31.7个月时，无病生存率、远处无病生存率和总生存率分别为78.6%、85.7%和94%。44%的患者接受了保乳手术。总体而言，TCH耐受性良好，3-4级不良事件发生率低，未报告晚期毒性反应或心脏功能障碍。
新辅助TCH，一种不含蒽环类药物的单阻断方案，pCR率达到47.6%。需要进一步进行分子分析，以确定更强的pCR预测标志物，从而准确选择不能从双阻断治疗中获益的患者。
