Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA.
Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA.
Breast. 2022 Aug;64:112-120. doi: 10.1016/j.breast.2022.05.005. Epub 2022 May 25.
Treatment protocols for invasive lobular breast cancer (ILC) have largely followed those for invasive ductal breast cancer. This study compares treatment outcomes of endocrine therapy versus combined chemo-endocrine therapy in hormone-receptor-positive (HR+), HER2-positive (HER2+) ILC tumors in a large national registry.
We sampled the National Cancer Database (2010-2016) for female patients with stages I-III, HR+/HER2+ ILC who underwent surgery. Cochran-Armitage trend test examined trends of treatment regimen administration: Surgery only (S), chemotherapy (C), endocrine therapy (ET), and combined chemo-endocrine therapy (CET), with or without anti-HER2 therapy. Cox proportional hazard model were used to compare overall survival (OS) across ET and CET cohorts, stratifying for anti-HER2 therapy, before and after propensity score match of cohorts (2013-2016). Kaplan-Meier (KM) survival curves were also produced.
N=11,421 were included. 58.7% of patients received Anti-Her2 therapy after 2013. CET conferred better OS over ET in the unmatched (adjusted-5-year-OS: 92.5% vs. 81.1%, p<0.001) and PS-matched (90.4% vs. 84.5%, p=0.001) samples. ET caused lower OS in patients who received Anti-Her2 therapy (HR: 2.56, 95% CI: 1.60-4.12, p<0.001) and patients who did not (HR: 1.84, 95% CI: 1.21-2.78, p=0.004), as compared to CET on multivariable analysis. KM modeling showed highest OS in the CET cohort who received Anti-Her2 (93.0%), followed by the CET cohort who did not receive Anti-Her2 (90.2%) (p=0.06).
Chemotherapy followed by endocrine therapy and Anti-Her2 therapy was shown to be the most effective treatment modality in HR+/HER2+ ILC, contrasting previous data on the inconclusive benefit of chemotherapy in patients with ILC.
浸润性小叶乳腺癌（ILC）的治疗方案在很大程度上与浸润性导管乳腺癌的治疗方案一致。本研究比较了激素受体阳性（HR+）、HER2 阳性（HER2+）ILC 肿瘤在大型国家数据库中内分泌治疗与联合化疗内分泌治疗的治疗结果。
我们从 2010 年至 2016 年的国家癌症数据库中抽取了接受手术治疗的 I 期至 III 期 HR+/HER2+ILC 女性患者。Cochran-Armitage 趋势检验用于检验治疗方案的管理趋势：仅手术（S）、化疗（C）、内分泌治疗（ET）和联合化疗内分泌治疗（CET），是否联合抗 HER2 治疗。使用 Cox 比例风险模型比较 ET 和 CET 队列的总生存（OS），在队列匹配（2013-2016）后分层抗 HER2 治疗。还制作了 Kaplan-Meier（KM）生存曲线。
共纳入 11421 例患者。58.7%的患者在 2013 年后接受了抗 HER2 治疗。CET 在未匹配（调整 5 年 OS：92.5%对 81.1%，p<0.001）和 PS 匹配（90.4%对 84.5%，p=0.001）样本中均优于 ET。ET 导致接受抗 HER2 治疗的患者（HR：2.56，95%CI：1.60-4.12，p<0.001）和未接受抗 HER2 治疗的患者（HR：1.84，95%CI：1.21-2.78，p=0.004）的 OS 降低，与多变量分析中的 CET 相比。KM 建模显示，接受抗 HER2 治疗的 CET 队列的 OS 最高（93.0%），其次是未接受抗 HER2 治疗的 CET 队列（90.2%）（p=0.06）。
与之前关于化疗对 ILC 患者获益不确定的数据相反，研究表明，在 HR+/HER2+ILC 中，化疗后联合内分泌治疗和抗 HER2 治疗是最有效的治疗方式。
