Improved surgical outcomes for breast cancer patients receiving neoadjuvant aromatase inhibitor therapy: results from a multicenter phase II trial.
Improved surgical outcomes for breast cancer patients receiving neoadjuvant aromatase inhibitor therapy: results from a multicenter phase II trial.
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DOI：
10.1016/j.jamcollsurg.2009.01.035
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发表时间：
2009-05
影响因子：
5.2
通讯作者：
Ellis, Matthew J.
中科院分区：
文献类型：
--
作者：
Olson, John A., Jr.;Budd, G. Thomas;Carey, Lisa A.;Harris, Lyndsay A.;Esserman, Laura J.;Fleming, Gini F.;Marcom, Paul K.;Leight, George S., Jr.;Giuntoli, Therese;Commean, Paul;Bae, Kyongtae;Luo, Jingqin;Ellis, Matthew J.
新辅助芳香化酶抑制剂治疗已被报道可改善绝经后临床II期或III期激素受体阳性乳腺癌患者的手术结局。进行了一项多中心II期临床试验，以研究这种方法在美国手术实践中的价值。115例绝经后女性，年龄>2 cm，雌激素受体（ER）或孕激素受体（PgR）阳性乳腺癌患者参加了一项为期16至24周的试验，术前每日服用来曲唑2.5 mg。106例患者符合初步分析的条件，96例接受手术，7例在疾病进展后接受化疗，3例未接受手术。48例（45%）患者的基线手术状态为保乳手术（BCS）边缘，47例明确不适合BCS（44%），11例无法通过标准乳房切除术（10%）进行手术。乳腺实体瘤临床反应率为62%，12%发生疾病进展。50%的患者接受了BCS，包括46例最初边缘BCS的患者中的30例（65%）和39例最初不适合BCS的患者中的15例（38%）。所有11例不能手术的患者均成功接受了手术，其中3例（27%）患有BCS。接受乳房切除术的患者中有19%患有病理性T1肿瘤，这表明一些高反应性肿瘤被过度手术治疗。新辅助芳香化酶抑制剂可改善手术性并促进BCS，但反应性存在相当大的差异。更好的技术来预测反应，术前确定残留肿瘤负荷，以及更愿意在反应患者中尝试BCS可以额外提高BCS的成功率。
Neoadjuvant aromatase inhibitor therapy has been reported to improve surgical outcomes for postmenopausal women with clinical stage II or III hormone receptor-positive breast cancer. A multicenter phase II clinical trial was conducted to investigate the value of this approach for US surgical practice. One hundred fifteen postmenopausal women with >2 cm, estrogen receptor (ER) or progesterone receptor (PgR)–positive breast cancer were enrolled in a trial of 16 to 24 weeks of letrozole 2.5 mg daily before operation. One hundred six patients were eligible for primary analysis, 96 underwent operations, 7 received chemotherapy after progressive disease, and 3 did not undergo an operation. Baseline surgical status was marginal for breast-conserving surgery (BCS) in 48 (45%), 47 were definitely ineligible for BCS (44%), and 11 were inoperable by standard mastectomy (10%). Overall Response Evaluation Criteria In Solid Tumors clinical response rate in the breast was 62%, with 12% experiencing progressive disease. Fifty percent underwent BCS, including 30 of 46 (65%) patients who were initially marginal for BCS and 15 of 39 (38%) patients who were initially ineligible for BCS. All 11 inoperable patients successfully underwent operations, including 3 (27%) who had BCS. Nineteen percent of patients undergoing mastectomy had a pathologic T1 tumor, suggesting that some highly responsive tumors were overtreated surgically. Neoadjuvant aromatase inhibitor improves operability and facilitates BCS, but there was considerable variability in responsiveness. Better techniques to predict response, determine residual tumor burden before operation, and greater willingness to attempt BCS in responsive patients could additionally improve the rate of successful BCS.
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DOI：
10.1093/jnci/djn309
发表时间：
2008-10-01
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Ellis MJ;Tao Y;Luo J;A'Hern R;Evans DB;Bhatnagar AS;Chaudri Ross HA;von Kameke A;Miller WR;Smith I;Eiermann W;Dowsett M
通讯作者：
Dowsett M
影响因子：
45.3
作者：
Smith, IE;Dowsett, M;Walsh, G
通讯作者：
Walsh, G
影响因子：
11.5
作者：
Colleoni, M;Viale, G;Goldhirsch, A
通讯作者：
Goldhirsch, A
影响因子：
6.2
作者：
Cataliotti, L;Buzdar, AU;de Oliveira, CT
通讯作者：
de Oliveira, CT
影响因子：
50.5
作者：
Eiermann, W;Paepke, S;Semiglazov, V
通讯作者：
Semiglazov, V