Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance).
Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance).
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DOI：
10.1097/sla.0000000000001417
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发表时间：
2015-09
影响因子：
9
通讯作者：
Alliance for Clinical Trials in Oncology
中科院分区：
文献类型：
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作者：
Golshan M;Cirrincione CT;Sikov WM;Berry DA;Jasinski S;Weisberg TF;Somlo G;Hudis C;Winer E;Ollila DW;Alliance for Clinical Trials in Oncology
评估新辅助全身治疗（NST）在提高三阴性乳腺癌保乳治疗（BCT）成功率方面的疗效。诱导肿瘤消退以允许BCT经常被引用来支持NST的施用。为了量化这一获益，我们对CALGB 40603进行了一项手术伴随研究，这是一项随机II期、2×2析因试验，在II-III期三阴性乳腺癌患者中进行紫杉醇±卡铂±贝伐珠单抗（B）新辅助治疗，随后进行多柔比星+环磷酰胺± B。在NST前后，治疗外科医生通过临床放射学标准评估BCT候选人;手术由外科医生和患者自行决定。我们测量了（1）从BCT不合格到BCT合格的转换率，（2）BCT候选人的手术选择，（3）BCT成功率和无肿瘤边缘。404例患者的手术结果可评估。219名（54%）在NST之前是BCT候选人。197人（90%）在NST后仍然是BCT候选人，其中138人（70%）选择了BCT，130人（94%）成功。在185名（46%）在NST之前不是BCT候选人的人中，78名（42%）转换为NST候选人。其中，53例（68%）选择BCT，成功率为91%（48/53）。使用NST的整体BCT合格率从54%上升到68%（275/404）。加入卡铂、B或两者均可提高转化率。这是第一项前瞻性记录从BCT不合格到BCT合格的转换率为42%的研究，导致BCT合格性绝对增加14%。BCT在93%的选择它的患者中是成功的，但31%的符合BCT条件的患者仍然选择乳房切除术。
To assess the efficacy of neoadjuvant systemic therapy (NST) at increasing the rate of successful breast-conserving therapy (BCT) in triple negative breast cancer. Inducing tumor regression to permit BCT is often cited to support administration of NST. To quantify this benefit, we conducted a surgical companion study to CALGB40603, a randomized phase II, 2×2 factorial trial of neoadjuvant paclitaxel ± carboplatin ± bevacizumab (B) followed by doxorubicin plus cyclophosphamide ± B in stage II–III triple negative breast cancer. Before and after NST, treating surgeons evaluated BCT candidacy by clinico-radiographic criteria; surgery performed was at surgeon and patient discretion. We measured (1) conversion rates from BCT-ineligible to BCT-eligible, (2) surgical choices in BCT candidates, and (3) rates of successful BCT with tumor-free margins. Four hundred four patients were assessable for surgical outcomes. Two hundred nineteen (54%) were BCT candidates before NST. One hundred ninety-seven (90%) remained BCT candidates after NST, of whom 138 (70%) chose BCT, which was successful in 130 (94%). Of 185 (46%) who were not BCT candidates before NST, 78 (42%) converted to candidates with NST. Of these, 53 (68%) chose BCT with a 91% (48/53) success rate. The overall BCT-eligibility rate rose from 54% to 68% (275/404) with NST. Addition of carboplatin, B, or both increased conversion rates. This is the first study to document prospectively a 42% conversion rate from BCT-ineligible to BCT-eligible, resulting in a 14% absolute increase in BCT eligibility. BCT was successful in 93% of patients who opted for it, but 31% of BCT-eligible patients still chose mastectomy.