HER2靶向治疗或雄激素剥夺疗法在涎腺导管癌中的生存获益。
Survival benefit of HER2-targeted or androgen deprivation therapy in salivary duct carcinoma.
作者信息
Kawakita Daisuke, Nagao Toshitaka, Takahashi Hideaki, Kano Satoshi, Honma Yoshitaka, Hirai Hideaki, Saigusa Natsuki, Akazawa Kohei, Tani Kaori, Ojiri Hiroya, Tsukahara Kiyoaki, Ozawa Hiroyuki, Okami Kenji, Kondo Takahito, Togashi Takafumi, Fushimi Chihiro, Shimura Tomotaka, Shimizu Akira, Okamoto Isaku, Okada Takuro, Imanishi Yorihisa, Watanabe Yoshihiro, Otsuka Kuninori, Sakai Akihiro, Ebisumoto Koji, Sato Yuichiro, Yamazaki Keisuke, Ueki Yushi, Hanazawa Toyoyuki, Saito Yuki, Ando Mizuo, Matsuki Takashi, Nakaguro Masato, Sato Yukiko, Urano Makoto, Utsumi Yoshitaka, Kohsaka Shinji, Saotome Takashi, Tada Yuichiro
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Anatomic Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
出版信息
Ther Adv Med Oncol. 2022 Sep 6;14:17588359221119538. doi: 10.1177/17588359221119538. eCollection 2022.
BACKGROUND
The efficacy and safety of human epidermal growth factor receptor 2 (HER2)-targeted therapy and androgen deprivation therapy (ADT) for locally advanced or recurrent or metastatic (LA/RM) salivary duct carcinoma (SDC) have been reported in prospective studies. However, the survival benefit of these therapies to conventional therapy remains controversial, and whether HER2-targeted therapy or ADT should be chosen in HER2- and androgen receptor (AR)-positive SDC patients remains unknown.
METHODS
Overall, 323 LA/RM SDC patients treated at seven institutions between August 1992 and June 2020 were retrospectively enrolled. The primary aim was to analyze the effect of HER2-targeted therapy and ADT on overall survival from the diagnosis of LA/RM disease to death from any cause (OS1). The secondary indicators included the overall response rate (ORR), clinical benefit rate (CBR), overall survival from therapy initiation for LA/RM disease (OS2), progression-free survival (PFS), time to second progression (PFS2), duration of response (DoR), and duration of clinical benefit (DoCB) of HER2-targeted therapy or ADT as first-line therapy for HER2-positive/AR-positive SDC.
RESULTS
Patients treated with HER2-targeted therapy or ADT had longer OS1 than those treated without these therapies (Median OS1: historical control, 21.6 months; HER2-targeted therapy, 50.6 months; ADT, 32.8 months; HER2-targeted therapy followed by ADT, 42.4 months; and ADT followed by HER2-targeted therapy, 45.2 months, < 0.001). Among HER2-positive/AR-positive SDC patients, although HER2-targeted therapy had better ORR, CBR, and PFS than those of ADT as first-line therapy, we found no significant differences between HER2-targeted therapy and ADT regarding OS2, PFS2, DoR, and DoCB.
CONCLUSION
Patients treated with HER2-targeted therapy and ADT showed longer survival in LA/RM SDC. HER2-targeted therapy can be recommended prior to ADT for HER2-positive/AR-positive SDC. It is warranted to establish a biomarker that could predict the efficacy of clinical benefit or better response in ADT.
背景
前瞻性研究已报道了人表皮生长因子受体2（HER2）靶向治疗和雄激素剥夺治疗（ADT）用于局部晚期或复发或转移性（LA/RM）涎腺导管癌（SDC）的疗效和安全性。然而，这些治疗相对于传统治疗的生存获益仍存在争议，且在HER2和雄激素受体（AR）阳性的SDC患者中应选择HER2靶向治疗还是ADT尚不清楚。
方法
总体而言，回顾性纳入了1992年8月至2020年6月期间在7家机构接受治疗的323例LA/RM SDC患者。主要目的是分析HER2靶向治疗和ADT对从LA/RM疾病诊断至任何原因死亡的总生存期（OS1）的影响。次要指标包括HER2靶向治疗或ADT作为HER2阳性/AR阳性SDC一线治疗的总缓解率（ORR）、临床获益率（CBR）、从LA/RM疾病治疗开始的总生存期（OS2）、无进展生存期（PFS）、至第二次进展时间（PFS2）、缓解持续时间（DoR）和临床获益持续时间（DoCB）。
结果
接受HER2靶向治疗或ADT的患者的OS1长于未接受这些治疗的患者（OS1中位数：历史对照，21.6个月；HER2靶向治疗，50.6个月；ADT，32.8个月；HER2靶向治疗后行ADT，42.4个月；ADT后行HER2靶向治疗，45.2个月，P<0.001）。在HER2阳性/AR阳性的SDC患者中，尽管HER2靶向治疗作为一线治疗的ORR、CBR和PFS优于ADT，但我们发现HER2靶向治疗和ADT在OS2、PFS2、DoR和DoCB方面无显著差异。
结论
接受HER2靶向治疗和ADT的LA/RM SDC患者生存期更长。对于HER2阳性/AR阳性的SDC，可在ADT之前推荐HER2靶向治疗。有必要建立一种生物标志物，以预测ADT中的临床获益疗效或更好反应。
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