Discipline of Pathology, Lambe Institute for Translational Research, NUI Galway, Costello Road, Galway, Ireland.
Department of Medical Oncology, University Hospital Galway, Galway, Ireland.
Breast Cancer Res Treat. 2019 Feb;174(1):1-13. doi: 10.1007/s10549-018-5066-6. Epub 2018 Nov 28.
PURPOSE: The rate of pathological complete response (pCR) for patients with triple negative breast cancer (TNBC) is increased when carboplatin is added to neo-adjuvant chemotherapy (NACT). However, while phase III trial data showing a survival benefit are awaited, carboplatin is not yet standard-of-care for TNBC. The aim of this study was to examine the rate of pCR and the outcome for those treated with carboplatin and to examine the predictors of response to therapy. METHODS: The retrospective series comprised 333 consecutive patients with TNBC (median follow-up time, 43 months). Adjuvant chemotherapy was given to 51% (n = 168) of patients and 29% (n = 97) received anthracycline-taxane NACT with carboplatin given to 9% (n = 31) of patients. RESULTS: Overall, 25% (n = 78) of patients experienced a breast cancer recurrence and 22% (n = 68) died from disease. A pCR breast and pCR breast/axilla was more common in those who received carboplatin (n = 18, 58% and n = 17, 55%, respectively) compared those who did not (n = 23, 36% and n = 18, 28%, respectively) (p = 0.041 and p = 0.011, respectively). By multivariable analysis, carboplatin and high tumor grade were independent predictors of pCR breast/axilla (OR = 0.17; 95% CI 0.06-0.54; p = 0.002; and OR = 0.05, 95% CI 0.01-0.27; p < 0.001, respectively). pCR breast/axilla was an independent predictor of DFS (HR=6.23; 95% CI 1.36-28.50; p = 0.018), metastasis-free survival (HR = 5.08; 95% CI 1.09-23.65; p = 0.038) and BCSS (HR = 8.52; 95% CI 1.09-66.64; p = 0.041). CONCLUSION: Carboplatin therapy and high tumor grade are associated with a significant increase in the rate of pCR, which is an independent predictor of outcome. These data support the use of carboplatin in NACT for TNBC, while results from phase III studies are awaited.
目的:对于三阴性乳腺癌(TNBC)患者,添加卡铂到新辅助化疗(NACT)可提高病理完全缓解(pCR)率。然而,尽管等待着显示生存获益的 III 期试验数据,但卡铂尚未成为 TNBC 的标准治疗方法。本研究旨在检查接受卡铂治疗的患者的 pCR 率和结局,并检查对治疗反应的预测因素。
方法:回顾性系列研究纳入了 333 例连续的 TNBC 患者(中位随访时间为 43 个月)。51%(n=168)的患者接受了辅助化疗,29%(n=97)接受了蒽环类药物-紫杉烷类 NACT,9%(n=31)的患者接受了卡铂治疗。
结果:总体而言,25%(n=78)的患者发生了乳腺癌复发,22%(n=68)死于疾病。接受卡铂治疗的患者(n=18,58%)和未接受卡铂治疗的患者(n=23,36%)的 pCR 乳房和 pCR 乳房/腋窝更为常见(n=17,55%和 n=18,28%)(p=0.041 和 p=0.011)。通过多变量分析,卡铂和高肿瘤分级是 pCR 乳房/腋窝的独立预测因素(OR=0.17;95%CI 0.06-0.54;p=0.002;和 OR=0.05,95%CI 0.01-0.27;p<0.001)。pCR 乳房/腋窝是 DFS(HR=6.23;95%CI 1.36-28.50;p=0.018)、无转移生存(HR=5.08;95%CI 1.09-23.65;p=0.038)和 BCSS(HR=8.52;95%CI 1.09-66.64;p=0.041)的独立预测因素。
结论:卡铂治疗和高肿瘤分级与 pCR 率的显著增加相关,pCR 是结局的独立预测因素。这些数据支持在 TNBC 的 NACT 中使用卡铂,同时等待 III 期研究的结果。
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