Lobefaro Riccardo, Zattarin Emma, Nichetti Federico, Prisciandaro Michele, Ligorio Francesca, Brambilla Marta, Sepe Pierangela, Corti Francesca, Peverelli Giorgia, Ottini Arianna, Beninato Teresa, Mazzeo Laura, Rea Carmen G, Mariani Gabriella, de Braud Filippo, Bianchi Giulia V, Vernieri Claudio, Capri Giuseppe
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
Ther Adv Med Oncol. 2020 Dec 7;12:1758835920970081. doi: 10.1177/1758835920970081. eCollection 2020.
Neoadjuvant anthracycline-taxane-based chemotherapy (ChT) is a standard of care treatment option for stage II-III breast cancer (BC) patients. However, the optimal duration of neoadjuvant ChT has been poorly investigated so far.
We retrospectively retrieved clinical data of patients with stage II-III human epidermal growth factor receptor 2-negative (HER2-) BC who were treated between October 2007 and January 2018 with neoadjuvant AT (doxorubicin-paclitaxel) for three cycles followed by CMF (cyclophosphamide-methotrexate-5-fluorouracil) for three cycles (cohort A) or with four AT cycles followed by four CMF cycles (cohort B). The aim of our study was to investigate the impact of neoadjuvant ChT duration (cohort A cohort B) on pathological complete response (pCR) rates, disease-free survival (DFS) and overall survival (OS).
Of 209 HER2- BC patients included, 62 had triple-negative breast cancer (TNBC) and 147 had hormone receptor-positive (HR+) BC. Median age was 48 years (range 30-74 years). A total of 111 patients belonged to cohort A and 98 patients belonged to cohort B. pCR was detected in 29 (13.9%) patients, 25 (40.3%) of whom had TNBC and four (2.7%) had HR+ HER2- BC. Patients achieving pCR had significantly longer DFS and OS, with statistical significance reached only in patients with TNBC. We found no differences between cohort A and cohort B in terms of pCR rates (15.3% 12.2%; = 0.55), DFS ( = 0.49) or OS ( = 0.94). The incidence of grade 3/4 adverse events was similar in cohort A cohort B as well (22.5% 19.4%; = 0.54).
Shorter duration of neoadjuvant anthracycline-taxane ChT was not associated with worse clinical outcomes in patients with stage II-III BC. Prospective studies are needed to evaluate whether the duration of neoadjuvant anthracycline-taxane-based ChT can be reduced in specific patient subgroups without negatively affecting clinical outcomes.
基于蒽环类药物和紫杉烷的新辅助化疗（ChT）是II - III期乳腺癌（BC）患者的标准治疗选择。然而，迄今为止，新辅助ChT的最佳疗程尚未得到充分研究。
我们回顾性检索了2007年10月至2018年1月期间接受新辅助AT（多柔比星 - 紫杉醇）三个周期然后CMF（环磷酰胺 - 甲氨蝶呤 - 5 - 氟尿嘧啶）三个周期治疗的II - III期人表皮生长因子受体2阴性（HER2 - ）BC患者的临床数据（队列A），或接受四个AT周期然后四个CMF周期治疗的患者（队列B）。我们研究的目的是调查新辅助ChT疗程（队列A与队列B）对病理完全缓解（pCR）率、无病生存期（DFS）和总生存期（OS）的影响。
纳入的209例HER2 - BC患者中，62例为三阴性乳腺癌（TNBC），147例为激素受体阳性（HR + ）BC。中位年龄为48岁（范围30 - 74岁）。共有111例患者属于队列A，98例患者属于队列B。29例（13.9%）患者检测到pCR，其中25例（40.3%）为TNBC，4例（2.7%）为HR + HER2 - BC。达到pCR的患者DFS和OS明显更长，仅在TNBC患者中具有统计学意义。我们发现队列A和队列B在pCR率（15.3%对12.2%；P = 0.55）、DFS（P = 0.49）或OS（P = 0.94）方面没有差异。队列A和队列B中3/4级不良事件的发生率也相似（22.5%对19.4%；P = 0.54）。
II - III期BC患者新辅助蒽环类药物 - 紫杉烷ChT疗程较短与较差的临床结局无关。需要进行前瞻性研究来评估在不负面影响临床结局的情况下，特定患者亚组中基于蒽环类药物和紫杉烷的新辅助ChT疗程是否可以缩短。
