To Nhu Hanh, Gabelle-Flandin Isabelle, Luong Thi My Hanh, Loganadane Gokoulakrichenane, Ouidir Nabila, Boukhobza Chahrazed, Grellier Noémie, Verry Camille, Thiolat Allan, Cohen José L, Radosevic-Robin Nina, Belkacemi Yazid
Department of Radiation Oncology and The Henri Mondor Breast Center, Henri Mondor University Hospital, AP-HP, 1 Rue Gustave Eiffel, 94010 Creteil, France.
INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), University of Paris-Est Creteil (UPEC), 94000 Creteil, France.
Cancers (Basel). 2023 Mar 29;15(7):2030. doi: 10.3390/cancers15072030.
Radiation therapy (RT), a novel approach to boost the anticancer immune response, has been progressively evaluated in the neoadjuvant setting in breast cancer (BC).
We aimed to evaluate immunity-related indicators of response to neoadjuvant chemoradiation therapy (NACRT) in BC for better treatment personalization.
We analyzed data of the first 42 patients included in the randomized phase 2 Neo-APBI-01 trial comparing standard neoadjuvant chemotherapy (NACT) and NACRT regimen in locally advanced triple-negative (TN) and luminal B (LB) subtype BC. Clinicopathological parameters, blood counts and the derived parameters, total tumor-infiltrating lymphocytes (TILs) and their subpopulation, as well as mutation status, were assessed as predictors of response.
Twenty-one patients were equally assigned to each group. The pathologic complete response (pCR) was 33% and 38% in the NACT and NACRT groups, respectively, with a dose-response effect. Only one LB tumor reached pCR after NACRT. Numerous parameters associated with response were identified, which differed according to the assigned treatment. In the NACRT group, baseline hemoglobin of ≥13 g/dL and body mass index of <26 were strongly associated with pCR. Higher baseline neutrophils-to-lymphocytes ratio, total TILs, and T-effector cell counts were favorable for pCR.
This preliminary analysis identified LB and low-TIL tumors as poor responders to the NACRT protocol, which delivered RT after several cycles of chemotherapy. These findings will allow for amending the selection of patients for the trial and help better design future trials of NACRT in BC.
放射治疗（RT）作为一种增强抗癌免疫反应的新方法，已在乳腺癌（BC）的新辅助治疗中逐步得到评估。
我们旨在评估BC患者对新辅助放化疗（NACRT）反应的免疫相关指标，以实现更好的个性化治疗。
我们分析了随机2期Neo-APBI-01试验纳入的前42例患者的数据，该试验比较了局部晚期三阴性（TN）和luminal B（LB）亚型BC的标准新辅助化疗（NACT）和NACRT方案。评估临床病理参数、血细胞计数及其衍生参数、肿瘤浸润淋巴细胞总数（TILs）及其亚群以及突变状态，作为反应的预测指标。
每组各分配21例患者。NACT组和NACRT组的病理完全缓解（pCR）率分别为33%和38%，存在剂量反应效应。NACRT后只有1例LB肿瘤达到pCR。确定了许多与反应相关的参数，这些参数因分配的治疗方法而异。在NACRT组中，基线血红蛋白≥13 g/dL和体重指数<26与pCR密切相关。较高的基线中性粒细胞与淋巴细胞比值、总TILs和T效应细胞计数有利于pCR。
这项初步分析确定LB肿瘤和低TIL肿瘤对在几个化疗周期后进行放疗的NACRT方案反应较差。这些发现将有助于修改试验患者的选择，并有助于更好地设计未来BC的NACRT试验。
