Al-Share Bayan, Assad Hadeel, Abrams Judith, Deol Abhinav, Alavi Asif, Modi Dipenkumar, Kin Andrew, Ratanatharathorn Voravit, Uberti Joseph, Ayash Lois
Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA.
J Oncol. 2022 Sep 30;2022:3472324. doi: 10.1155/2022/3472324. eCollection 2022.
Women with locally advanced/high-risk triple-negative breast cancer treated with the current standard chemotherapy continue to have a poor prognosis. High-dose chemotherapy with autologous stem cell transplant as treatment for locally advanced/high-risk breast cancer remains controversial due to a lack of survival benefit seen in previous phase III trials. However, these trials evaluated a heterogeneous group of patients with different receptor subtypes. A marginal benefit was observed in certain subgroups. We report long-term outcomes of women with stage IIB or III triple-negative breast cancer treated with high-dose chemotherapy followed by autologous stem cell transplant at our institution between 1995 and 2001.
This is a retrospective analysis of stage IIB or stage III triple-negative breast cancer treated with high-dose chemotherapy followed by autologous stem cell transplant. We excluded women with hormone-positive, HER2/neu-positive/unknown, and/or metastatic disease prior to transplant as per updated AJCC 7 edition guidelines. Patients underwent surgery and either neoadjuvant or adjuvant anthracycline and taxane-based chemotherapy and then proceeded to high-dose chemotherapy and autologous stem cell transplant using carmustine 600 mg/sqm, cyclophosphamide 5.6gm/sqm, and cisplatin 165 mg/sqm (STAMP 1 regimen) for consolidation. This was followed by locoregional breast and lymph node radiation per standard of care.
Twenty-nine women (2 stage IIB and 27 stage III) were evaluated. The median age at diagnosis was 43 years (IQR: 40, 51). Eleven patients had 4-9 regional lymph nodes (LN) involved and 16 had 10+ involved LNs. Four patients had T4 or inflammatory breast cancer and two had ipsilateral supraclavicular LNs involved. The median follow-up time is 16 years (95% CI: 12, 19, range <1-19 y) posttransplant. The median overall survival was 15 years (95% CI: 3, 19); the median DFS was 14 years (95% CI: 1, 19).
This study of locally advanced/high-risk triple-negative breast cancer treated with adjuvant high-dose chemotherapy and autologous stem cell transplant reveals high overall survival rate. With the current improvement in treatment-related mortality, re-evaluating this approach in this subset of high-risk breast cancer in prospective randomized studies may be worthwhile.
接受当前标准化疗的局部晚期/高危三阴性乳腺癌女性患者的预后仍然较差。由于在先前的III期试验中未观察到生存获益，高剂量化疗联合自体干细胞移植作为局部晚期/高危乳腺癌的治疗方法仍存在争议。然而，这些试验评估的是一组受体亚型不同的异质性患者。在某些亚组中观察到了边际获益。我们报告了1995年至2001年间在我们机构接受高剂量化疗后进行自体干细胞移植的IIB期或III期三阴性乳腺癌女性患者的长期结局。
这是一项对接受高剂量化疗后进行自体干细胞移植的IIB期或III期三阴性乳腺癌的回顾性分析。根据美国癌症联合委员会（AJCC）第7版更新指南，我们排除了移植前激素阳性、HER2/neu阳性/未知和/或有转移性疾病的女性患者。患者接受手术以及新辅助或辅助蒽环类和紫杉类化疗，然后进行高剂量化疗和自体干细胞移植，使用卡莫司汀600mg/m²、环磷酰胺5.6g/m²和顺铂165mg/m²（STAMP 1方案）进行巩固治疗。随后按照标准治疗方案进行局部乳腺和淋巴结放疗。
评估了29名女性患者（2例IIB期和27例III期）。诊断时的中位年龄为43岁（四分位间距：40，51）。11例患者有4 - 9个区域淋巴结受累，16例患者有10个及以上淋巴结受累。4例患者有T4或炎性乳腺癌，2例患者同侧锁骨上淋巴结受累。移植后的中位随访时间为16年（95%置信区间：12，19，范围<1 - 19年）。中位总生存期为15年（95%置信区间：3，19）；中位无病生存期为14年（95%置信区间：1，19）。
这项关于辅助高剂量化疗联合自体干细胞移植治疗局部晚期/高危三阴性乳腺癌的研究显示出较高的总生存率。鉴于目前治疗相关死亡率有所改善，在前瞻性随机研究中对这一高危乳腺癌亚组重新评估这种治疗方法可能是值得的。
