Gori Stefania, Fabi Alessandra, Angiolini Catia, Turazza Monica, Salvini Piermario, Ferretti Gianluigi, Cretella Elisabetta, Gianni Lorenzo, Bighin Claudia, Toss Angela, Zamagni Claudio, Vici Patrizia, De Rossi Costanza, Russo Antonio, Bisagni Giancarlo, Frassoldati Antonio, Borgato Lucia, Cariello Anna, Cappelletti Claudia, Bordonaro Roberto, Cinieri Saverio, Modena Alessandra, Valerio Matteo, Alvisi Maria Francesca, De Simone Irene, Galli Francesca, Rulli Eliana, Santoni Anna, Nicolis Fabrizio
Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy.
Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Cancers (Basel). 2023 Oct 4;15(19):4852. doi: 10.3390/cancers15194852.
To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics influenced oncologists in the decision to administer NAT in EBC and in the choice of the type of systemic therapy, according to ESMO and AIOM Guidelines. Currently, it is recommended always to evaluate the use of NAT in EBC, mainly in HER2+ and TN patients, considering that pCR is associated with significantly better survival of the patient and that effective therapies are now available for residual disease.
为评估意大利接受新辅助全身治疗（NAT）的早期乳腺癌（EBC）患者的比例、患者选择标准及所采用的治疗类型，我们对多中心前瞻性观察性BRIDE研究纳入的1633例患者中的1276例I-II-III期患者进行了分析。共有177例患者（13.9%）接受了NAT治疗，1099例（85.9%）接受了手术治疗；在多变量分析中，绝经状态、cT、cN、分级、HER2阳性和三阴性（TN）亚组与给予NAT的决定显著相关。所采用的NAT类型受EBC亚型影响。HER2+/HR阴性的EBC患者中有53.2%接受了NAT治疗，HER2+/HR阳性患者中有27.9%，HER2阴性/HR阳性患者中有7.1%，TN EBC患者中有30.3%。病理完全缓解（pCR）率与文献报道的相似：HER2+/HR阴性患者中为74.2%，HER2+/HR阳性患者中为52.3%，HER2阴性/HR阳性患者中为17.2%，TN患者中为37.9%。在临床实践中，根据欧洲肿瘤内科学会（ESMO）和意大利医学肿瘤学会（AIOM）指南，患者和肿瘤特征会影响肿瘤学家对EBC患者给予NAT的决定以及全身治疗类型的选择。目前，建议始终评估EBC患者中NAT的使用情况，主要是HER2阳性和TN患者，因为pCR与患者显著更好的生存率相关，而且现在有针对残留疾病的有效治疗方法。
