Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cancer. 2022 Aug 15;151(4):578-589. doi: 10.1002/ijc.34022. Epub 2022 Apr 19.
There is a scarcity of data exploring the long-term benefits of platinum-based (anthracycline-free) neoadjuvant chemotherapy (NACT) for triple-negative breast cancer (TNBC). The prospective cohort study was conducted at Cancer Hospital, Chinese Academy of Medical Sciences. Patients with TNBC in stage II-III were enrolled to receive NACT of dose-dense (dd) paclitaxel (175 mg/m ) plus carboplatin (AUC 4.0) biweekly (ddPCb) for 6 cycles, and matched patients during the same period who received standard adjuvant chemotherapy for survival comparison. From January 2014 to July 2021, 264 patients were included in the primary nonmatched analysis (neoadjuvant 99, adjuvant 165). Compared to those in the adjuvant group, patients receiving NACT had larger tumors, higher degrees of nodal burden and more advanced disease (P < .001). Almost all patients in the adjuvant group received epirubicin plus cyclophosphamide followed by paclitaxel. Within a median follow-up of 44.9 months, the 4-year recurrence-free survival (RFS, 82.6% vs 75.4%) and overall survival (OS, 86.6% vs 80.5%) were higher for patients in the neoadjuvant group without statistical difference. In the matched cohort of 134 patients (67 pairs), the 4-year RFS (84.9% vs 60.9%; hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.15-0.69; P = .003) and OS (88.0% vs 65.9%, HR, 0.30, 95% CI, 0.12-0.75, P = .010) were significantly superior for platinum-based neoadjuvant than standard adjuvant chemotherapy. Compared to standard chemotherapy, ddPCb was related to less neutropenia and more thrombocytopenia. These results support the consideration of ddPCb as NACT for TNBC in stage II-III. Randomized data and predictive biomarkers for platinum-based chemotherapy are needed to be further investigated.
目前，关于无蒽环类药物的含铂方案新辅助化疗（NACT）治疗三阴性乳腺癌（TNBC）的长期获益数据较为匮乏。该前瞻性队列研究在中国医学科学院肿瘤医院开展。研究纳入了 II-III 期 TNBC 患者，接受每 2 周 1 次的密集型紫杉醇（175mg/m ）加卡铂（AUC 4.0）（ddPCb）方案的 6 周期 NACT，同期匹配接受标准辅助化疗的患者进行生存比较。2014 年 1 月至 2021 年 7 月，共有 264 例患者纳入非匹配的初步分析（新辅助组 99 例，辅助组 165 例）。与辅助组相比，新辅助组患者的肿瘤更大，淋巴结受累程度更高，疾病分期更晚（P < .001）。辅助组几乎所有患者均接受表柔比星联合环磷酰胺序贯紫杉醇治疗。中位随访 44.9 个月时，新辅助组患者的 4 年无复发生存率（RFS，82.6% vs 75.4%）和总生存率（OS，86.6% vs 80.5%）更高，但无统计学差异。在匹配的 134 例患者队列（67 对）中，新辅助组的 4 年 RFS（84.9% vs 60.9%；风险比[HR]，0.32；95%置信区间[CI]，0.15-0.69；P = .003）和 OS（88.0% vs 65.9%，HR，0.30，95%CI，0.12-0.75，P = .010）均显著优于标准辅助化疗。与标准化疗相比，ddPCb 相关的中性粒细胞减少症发生率较低，血小板减少症发生率较高。这些结果支持将 ddPCb 作为 II-III 期 TNBC 的 NACT 方案。需要进一步研究 ddPCb 方案用于 TNBC 的随机数据和预测生物标志物。
