Fang Yan, Wang Zheng, Wu Jiayi, Huang Ou, He Jianrong, Zhu Li, Chen Weiguo, Li Yafen, Chen Xiaosong, Shen Kunwei
Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China.
J Cancer. 2020 Feb 14;11(9):2602-2609. doi: 10.7150/jca.39509. eCollection 2020.
: This study aims to evaluate influence factors for adjuvant chemotherapy regimen choice on the basis of trastuzumab in older human epidermal growth factor receptor 2 (HER2)-positive breast cancer under multi-disciplinary team (MDT) modality. : HER2-positive breast cancer patients aged ≥ 60 years who received breast cancer surgery between April 2013 and December 2017 in Shanghai Ruijin Hospital were retrospectively enrolled. Clinical and pathological features, MDT recommendations, administration of adjuvant treatment, cardiotoxicity, and disease outcome information were reviewed and analyzed. : A total of 222 older HER2-positive breast cancer patients were included and recommended to receive adjuvant chemotherapy plus trastuzumab therapy. Paclitaxel plus trastuzumab (PH, 41/222, 18.5%), docetaxel plus carboplatin and trastuzumab (TCH, 62/222, 27.9%), and antharcyclines plus cyclophosphamide followed by taxanes and trastuzumab (AC-TH, 119/222, 53.6%) were the three main regimens. Patients with T1a-b (<0.001), grade 1-2 (=0.008), node-negative (<0.001), stage I (<0.001), low Ki-67 level (<0.001) disease, with cardiovascular comorbidities (=0.011), and aged ≥ 70 years (<0.001) were more likely to be recommended to PH regimen. Among the 178 patients who finally received adjuvant chemotherapy plus one-year trastuzumab treatment, only four patients (4/117, 3.4%) were recorded to have asymptomatic LVEF declining ≥ 10% but remaining ≥ 50% within one-year trastuzumab treatment. : Clinical factors, including age, tumor size, node status, and cardiovascular comorbidity influenced the recommendation of trastuzumab with chemotherapy for older HER2-positive breast cancer patients. Low risk older HER2-positive breast cancer patients treated with PH had favorable outcome and good cardiac safety, which needed further clinical validation.
本研究旨在评估在多学科团队（MDT）模式下，影响老年人类表皮生长因子受体2（HER2）阳性乳腺癌患者基于曲妥珠单抗选择辅助化疗方案的因素。回顾性纳入2013年4月至2017年12月在上海瑞金医院接受乳腺癌手术的年龄≥60岁的HER2阳性乳腺癌患者。对临床和病理特征、MDT建议、辅助治疗的实施、心脏毒性和疾病转归信息进行回顾和分析。共纳入222例老年HER2阳性乳腺癌患者，并建议接受辅助化疗加曲妥珠单抗治疗。三种主要方案为紫杉醇加曲妥珠单抗（PH，41/222，18.5%）、多西他赛加卡铂和曲妥珠单抗（TCH，62/222，27.9%）以及蒽环类药物加环磷酰胺序贯紫杉类药物和曲妥珠单抗（AC-TH，119/222，53.6%）。T1a-b期（<0.001）、1-2级（=0.008）、无淋巴结转移（<0.001）、I期（<0.001）、Ki-67水平低（<0.001）的疾病患者，有心血管合并症（=0.011）以及年龄≥70岁（<0.001）的患者更有可能被推荐接受PH方案。在最终接受辅助化疗加一年曲妥珠单抗治疗的178例患者中，仅有4例患者（4/117，3.4%）在曲妥珠单抗治疗1年内记录到无症状左心室射血分数下降≥10%但仍≥50%。临床因素，包括年龄、肿瘤大小、淋巴结状态和心血管合并症，影响老年HER2阳性乳腺癌患者曲妥珠单抗联合化疗的推荐。低风险老年HER2阳性乳腺癌患者接受PH方案治疗有良好的转归和心脏安全性，这需要进一步的临床验证。
