Iwase Toshiaki, Sridhar Nithya, Kai Megumi, Dong Wenli, Shen Yu, Krishnamurthy Savitri, Lucci Anthony, Le-Petross H T Carisa, Nasrazadani Azadeh, Saleem Sadia, Layman Rachel M, Valero Vincente, Tripathy Debasish, Woodward Wendy A, Cheng Yee Chung, Nakhlis Faina, Bellon Jenifer R, Lynce Filipa, Ueno Naoto T
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Breast Cancer Res Treat. 2025 Nov;214(1):69-77. doi: 10.1007/s10549-025-07795-3. Epub 2025 Aug 2.
Randomized clinical trials have shown no benefit from adding anthracyclines to neoadjuvant treatment for HER2-positive breast cancer; however, the efficacy in inflammatory breast cancer (IBC) is unknown. Here we compared pathologic response rates for preoperative regimens with or without anthracyclines in HER2-positive primary IBC.
We retrospectively reviewed patients diagnosed with HER2-positive primary IBC in 2014-2021 who received neoadjuvant therapy and modified radical mastectomy at MD Anderson Cancer Center, IBC Network institutions and Dana-Farber Cancer Institute. The primary outcome was a pathological complete response (pCR) rate. Secondary outcomes included time to local or regional recurrence (TLRR), event-free survival (EFS), and overall survival (OS). Univariate and multivariable analyses were performed with adjustments for clinically relevant covariates.
Of the 101 patients included, 39 received docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP), and 62 (docetaxel, trastuzumab, pertuzumab, doxorubicin, and cyclophosphamide) received THP-AC regimen. Median follow-up time was 3.02 years. The pCR rates did not differ by regimen type (48.7% TCHP vs. 53.2% THP-AC, p = 0.659). Multivariable logistic regression adjusted for age and estrogen receptor positivity showed no association between pCR or regimen. The multivariable Cox model showed that the patients who received THP-AC had longer TLRR (hazard ratio [HR] 0.279, 95% CI 0.102-0.765, p = 0.0131) and EFS (HR 0.462, 95% CI 0.228-0.936, p = 0.032), with no difference in OS.
These findings indicate that an anthracycline-containing neoadjuvant regimen is not associated with pCR, but may prolong disease control in patients with HER2-positive IBC. Further investigation of the optimal neoadjuvant regimen for such tumors is warranted.
随机临床试验表明，在人表皮生长因子受体2（HER2）阳性乳腺癌的新辅助治疗中添加蒽环类药物并无益处；然而，其在炎性乳腺癌（IBC）中的疗效尚不清楚。在此，我们比较了HER2阳性原发性IBC患者术前使用或不使用蒽环类药物的治疗方案的病理缓解率。
我们回顾性分析了2014年至2021年期间在MD安德森癌症中心、IBC网络机构和达纳-法伯癌症研究所被诊断为HER2阳性原发性IBC并接受新辅助治疗和改良根治性乳房切除术的患者。主要结局是病理完全缓解（pCR）率。次要结局包括局部或区域复发时间（TLRR）、无事件生存期（EFS）和总生存期（OS）。进行单变量和多变量分析，并对临床相关协变量进行调整。
纳入的101例患者中，39例接受了多西他赛、卡铂、曲妥珠单抗和帕妥珠单抗（TCHP）治疗，62例（多西他赛、曲妥珠单抗、帕妥珠单抗、阿霉素和环磷酰胺）接受了THP-AC方案治疗。中位随访时间为3.02年。不同治疗方案类型的pCR率无差异（TCHP组为48.7%，THP-AC组为53.2%，p = 0.659）。对年龄和雌激素受体阳性进行调整的多变量逻辑回归显示，pCR与治疗方案之间无关联。多变量Cox模型显示，接受THP-AC方案治疗的患者的TLRR更长（风险比[HR] 0.279，95%置信区间0.102 - 0.765，p = 0.0131）和EFS更长（HR 0.462，95%置信区间0.228 - 0.936，p = 0.032），OS无差异。
这些发现表明，含蒽环类药物的新辅助治疗方案与pCR无关，但可能延长HER2阳性IBC患者的疾病控制时间。对此类肿瘤的最佳新辅助治疗方案进行进一步研究是有必要的。
