Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas.
Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain.
Clin Cancer Res. 2018 Dec 1;24(23):5820-5829. doi: 10.1158/1078-0432.CCR-18-0585. Epub 2018 Jul 30.
Prognostic value of pathologic complete response (pCR) and extent of pathologic response attained with anthracycline-free platinum plus taxane neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) is unknown. We report recurrence-free survival (RFS) and overall survival (OS) according to degree of pathologic response in patients treated with carboplatin plus docetaxel NAC.
One-hundred and ninety patients with stage I-III TNBC were treated with neoadjuvant carboplatin (AUC6) plus docetaxel (75 mg/m) every 21 days × 6 cycles. pCR (no evidence of invasive tumor in breast and axilla) and Residual cancer burden (RCB) were evaluated. Patients were followed for recurrence and survival. Extent of pathologic response was associated with RFS and OS using the Kaplan-Meier method.
Median age was 51 years, and 52% were node-positive. pCR and RCB I rates were 55% and 13%, respectively. Five percent of pCR patients, 0% of RCB I patients, and 58% of RCB II/III patients received adjuvant anthracyclines. Three-year RFS and OS were 79% and 87%, respectively. Three-year RFS was 90% in patients with pCR and 66% in those without pCR [HR = 0.30; 95% confidence interval (CI), 0.14-0.62; = 0.0001]. Three-year OS was 94% in patients with pCR and 79% in those without pCR (HR = 0.25; 95% CI, 0.10-0.63; = 0.001). Patients with RCB I demonstrated 3-year RFS (93%) and OS (100%) similar to those with pCR. On multivariable analysis, higher tumor stage, node positivity, and RCB II/III were associated with worse RFS.
Neoadjuvant carboplatin plus docetaxel yields encouraging efficacy in TNBC. Patients achieving pCR or RCB I with this regimen demonstrate excellent 3-year RFS and OS without adjuvant anthracycline.
在三阴性乳腺癌（TNBC）中，病理完全缓解（pCR）和蒽环类药物免费的铂类加紫杉烷新辅助化疗（NAC）获得的病理缓解程度的预后价值尚不清楚。我们报告了接受卡铂加多西他赛 NAC 治疗的患者根据病理缓解程度的无复发生存率（RFS）和总生存率（OS）。
190 例 I-III 期 TNBC 患者接受新辅助卡铂（AUC6）加多西紫杉醇（75mg/m）每 21 天×6 周期。评估 pCR（乳房和腋窝无侵袭性肿瘤证据）和残留癌负担（RCB）。对患者进行复发和生存随访。采用 Kaplan-Meier 法比较病理缓解程度与 RFS 和 OS 的关系。
中位年龄为 51 岁，52%为淋巴结阳性。pCR 和 RCB I 的比例分别为 55%和 13%。5%的 pCR 患者、0%的 RCB I 患者和 58%的 RCB II/III 患者接受了辅助蒽环类药物治疗。3 年 RFS 和 OS 分别为 79%和 87%。pCR 患者的 3 年 RFS 为 90%，无 pCR 患者为 66%[HR=0.30；95%置信区间（CI），0.14-0.62；=0.0001]。pCR 患者的 3 年 OS 为 94%，无 pCR 患者为 79%（HR=0.25；95%CI，0.10-0.63；=0.001）。RCB I 患者的 3 年 RFS（93%）和 OS（100%）与 pCR 患者相似。多变量分析显示，较高的肿瘤分期、淋巴结阳性和 RCB II/III 与较差的 RFS 相关。
新辅助卡铂加多西他赛在 TNBC 中具有令人鼓舞的疗效。接受该方案治疗达到 pCR 或 RCB I 的患者，在没有辅助蒽环类药物的情况下，3 年 RFS 和 OS 均表现出色。
