Division of Medical Senology, European Institute of Oncology, Milan, Italy.
Division of Medical Senology, European Institute of Oncology, Milan, Italy.
Clin Breast Cancer. 2018 Aug;18(4):328-335. doi: 10.1016/j.clbc.2018.01.010. Epub 2018 Feb 2.
Inflammatory breast cancer (IBC) is a rare and highly aggressive disease. A neoadjuvant regimen with chemotherapy and an antiangiogenic strategy was investigated.
Patients with primary or recurrent IBC who were candidates for neoadjuvant treatment received weekly carboplatin and paclitaxel plus bevacizumab every 3 weeks and oral metronomic cyclophosphamide for 6 months. Trastuzumab was added for patients with HER2 tumors and endocrine therapy was added for patients with estrogen receptor and/or progesterone receptor ≥ 10% tumors. Oral metronomic capecitabine and cyclophosphamide was continued for 6 months after surgery in those patients with a response. The primary efficacy endpoints were pathologic complete remission (pCR) and the objective response.
From July 2010 to December 2013, 34 patients with IBC were included. The surrogate intrinsic tumor subtypes were as follows: luminal B-like (HER2), 10 (29%); luminal B-like (HER2), 8 (24%); HER2 (nonluminal), 6 (18%); and triple negative, 10 (29%). An objective response was obtained in 30 patients (88%; 95% confidence interval, 73%-97%) and a pCR in 10 patients (29%; 95% confidence interval, 15%-48%). The proportion of pCR was significantly greater in the patients with HER2 tumors (57%) than in patients with triple-negative (20%) or luminal B-like (HER2) tumors (0%; P = .019). After a median follow-up of 4.4 years, the 5-year disease-free survival and overall survival was 58% and 72%, respectively. The achievement of pCR was associated with longer disease-free (P = .12) and overall (P = .029) survival.
In patients with IBC, neoadjuvant treatment with the investigated regimen was successful and well tolerated. Further studies evaluating the potential benefit of an antiangiogenic strategy in this setting are awaited.
炎性乳腺癌（IBC）是一种罕见且高度侵袭性的疾病。本研究调查了一种新辅助化疗联合抗血管生成策略。
适合新辅助治疗的原发性或复发性 IBC 患者接受每周卡铂和紫杉醇联合贝伐珠单抗每 3 周一次，以及口服节拍式环磷酰胺 6 个月。对于 HER2 肿瘤患者加用曲妥珠单抗，对于雌激素受体和/或孕激素受体≥10%肿瘤患者加用内分泌治疗。对于有反应的患者，在手术后继续口服节拍式卡培他滨和环磷酰胺 6 个月。主要疗效终点为病理完全缓解（pCR）和客观缓解率。
2010 年 7 月至 2013 年 12 月，共纳入 34 例 IBC 患者。替代内在肿瘤亚型如下：管腔 B 样（HER2），10 例（29%）；管腔 B 样（HER2），8 例（24%）；HER2（非管腔），6 例（18%）；三阴性，10 例（29%）。30 例（88%；95%置信区间，73%-97%）患者获得客观缓解，10 例（29%；95%置信区间，15%-48%）患者获得 pCR。HER2 肿瘤患者的 pCR 比例显著高于三阴性（20%）或管腔 B 样（HER2）肿瘤患者（0%；P=0.019）。中位随访 4.4 年后，5 年无病生存率和总生存率分别为 58%和 72%。pCR 的获得与无病生存（P=0.12）和总生存（P=0.029）的延长相关。
在 IBC 患者中，该研究方案的新辅助治疗是成功且耐受良好的。需要进一步研究评估该治疗方案在该人群中的抗血管生成策略的潜在获益。
