Neoadjuvant therapy with concurrent anthracyclines and taxanes in Her2-negative breast cancer (HNBC): TAC legacy.
Neoadjuvant therapy with concurrent anthracyclines and taxanes in Her2-negative breast cancer (HNBC): TAC legacy.
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Her2 阴性乳腺癌 (HNBC) 中联合使用蒽环类药物和紫杉烷类药物的新辅助治疗：TAC 遗产。
DOI：
10.1200/jco.2022.40.16_suppl.e12629
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发表时间：
2022
影响因子：
45.3
通讯作者：
J. Bayo
中科院分区：
文献类型：
--
作者：
Victoria García Samblás;M. David;Isabel Aragón Manrique;J. Bayo
e12629背景：同时使用紫杉醇-阿霉素-环磷酰胺（TAC）的辅助治疗增加了淋巴结阳性乳腺癌的总生存期。然而，它与感染和心脏毒性的风险增加有关。换用表阿霉素（TEC）和加用非格司亭预防（GCSF）可能是新辅助治疗中有用且安全的选择。方法：我们回顾了新辅助化疗方案TEC x 6周期（c）和GCSF治疗HNBC的疗效和安全性。采用Kaplan-Meier、考克斯回归和二元Logistic回归分析影响生存预后的因素、病理学完全缓解率（pCR）和严重不良事件。结果：从2015年到2021年，登记了204例患者（pt）和1125个周期。中位随访39.4个月。中位年龄48岁（SD 8.3），II至IIIC期（35% IIB），64%为阳性淋巴结，25%为三阴性（TN）肿瘤。给药的中位剂量为90%（87.9-93.4），93%的累积剂量高于66%（相当于4 c）。75%患者的放射学反应。16.3%的患者达到pCR（LumA中3.2%，LumB中15%，TN肿瘤中35%）。TN的OR 4.98（2.18-11.35）和老年人的OR 0.94（0.89-0.99）p<0.05。PCR检测TN患者无复发。PCR在接受66%计划剂量的患者中是非劣效的（OR 1.3，p=0.76），LumB中的PCR高于LumA，OR 5.2（1.13- 24.61），p <0.05。基线时29.2%的受累淋巴结患者避免了淋巴结切除术。3年（y）无复发（F）生存率（S）为86.1%（91-80%），II期HR 0.29（0.14-0.58）和老年HR 0.93（0.89-0.98）预后更好，p< 0.005。3年总的FS为89%（93-84%），TN预后较差，HR为3.48（1.37-8.84）。II期风险较低，HR为0.31（0.13-0.75），培非格司亭为0.14（0.03-0.67），p<0.05。24%的人因任何原因入院。年龄较大（OR 1.05，p=0.01）。21%中性粒细胞减少G3/4。17.2%的患者感染。发热性中性粒细胞减少18.1%，与年龄（p=0.5）或培非格司亭Vs非格司亭（p=0.99）无关。虚弱17%，结肠炎6%，血栓形成2%。未报告心脏病事件。结论：TEC在HNBC的新辅助治疗中有效。其pCR和生存率与荟萃分析中报告的相似。GCSF有助于治疗依从性，但中性粒细胞减少症和入院的风险仍然存在。较低的累积剂量可能足以达到相同的结果。III期和TN的预后较差。
e12629 Background: Adyuvant therapy with Concurrent docetaxel-adriamycin-cyclophosphamide (TAC) increases overall survival in positive node breast cancer. However it is associated with an increased risk of infection and cardiotoxicity. Switching to epirubicin (TEC) and adding Filgrastim prophylaxis (GCSF) could be an useful and safe option in the neoadjuvant setting. Methods: We reviewed the efficacy and safety of neoadjuvant regimen TEC x 6 cycles(c) and GCSF in HNBC. Kaplan–Meier, Cox regression and binary logistic regression were performed to analyze survival prognostic factors, pathological complete response rate (pCR) and serious adverse events. Results: From 2015 to 2021, 204 patients (pt) and 1125 cycles were registered. Median follow-up of 39.4 months. Median age 48 years (SD 8.3), stage II to IIIC (35% IIB), 64% were positive node and 25% Triple Negative(TN) tumors. A median dose of 90% (87.9-93.4) was administered, 93% with a cumulative dose higher than 66% (equivalent to 4 c). Radiologic response in 75% pt. 16.3% pt achieved pCR (3.2% in LumA, 15% in LumB and 35% in TN tumors). OR 4.98 (2.18-11.35) for TN and OR 0.94 (0.89-0.99) for older p<0.05. No relapses were detected in TN patients with PCR. PCR was non-inferior in pt who received 66% of planned dose (OR 1.3, p=0.76) and was higher in LumB than LumA, OR 5.2 (1.13- 24.61), p <0.05. Lymphadenectomy was avoided in 29.2% of patients with affected node at baseline. 3 years (y) relapse free (F) survival (S) of 86.1% (91-80%), better prognosis in stage II HR 0.29 (0.14-0.58) and older HR 0.93 (0.89-0.98), p< 0.005. 3y overall FS of 89% (93-84%), worse prognosis in TN with HR 3.48 (1.37-8.84). Lower risk in stage II with HR 0.31 (0.13-0.75) and in Pegfilgastrim with HR 0.14 (0.03-0.67), p<0.05. Hospital admissions in 24% for any cause. Older age (OR 1.05, p=0.01). 21% neutropenia G3/4. Infections in 17.2% of pt. Febril neutropenia in 18.1%, no related to age (p=0.5) or pegfilgrastim Vs filgrastim (p=0.99). Asthenia 17%, colitis 6% and thrombosis in 2%. No cardiacs events were reported. Conclusions: TEC is effective in the neoadjuvant setting of HNBC. It has similar pCR and survivall to those reported in meta-analysis. GCSF facilitates treatment compliance but the risk of neutropenia and admissions are still present. A lower cumulative dose could be enough to achieve the same results. Stage III and TN have shown a worse prognosis.