Inclusion of taxanes, particularly weekly paclitaxel, in preoperative chemotherapy improves pathologic complete response rate in estrogen receptor-positive breast cancers
Inclusion of taxanes, particularly weekly paclitaxel, in preoperative chemotherapy improves pathologic complete response rate in estrogen receptor-positive breast cancers
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DOI：
10.1093/annonc/mdm008
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发表时间：
2007-05-01
影响因子：
50.5
通讯作者：
Pusztai, L.
中科院分区：
文献类型：
--
作者：
Mazouni, C.;Kau, S.-W.;Pusztai, L.
背景：我们研究了与3到4个疗程的5-氟尿嘧啶、阿霉素、环磷酰胺（FAC）相比，紫杉烷和更长的术前化疗是否能改善雌激素受体（ER）阳性乳腺癌的病理完全缓解（pCR）率。患者和方法：对7个连续新辅助化疗试验1079例患者的结果进行汇总分析。这些研究是从1974年到2001年在安德森癌症中心进行的。426例（39.5%）患者接受了紫杉烷为基础的新辅助治疗。分析pCR率和生存时间作为化疗方案和ER状态的函数。进行多变量逻辑分析和Cox回归分析，以确定与pCR和生存率相关的变量。结果：er阴性肿瘤患者的总体pCR率高于er阳性肿瘤患者（20.1%比4.9%,P < 0.001）。在er阴性患者中，有和没有紫杉烷的PCR率分别为29%和15% （P < 0.001）。在er阳性患者中，加和不加紫杉烷的pCR率分别为8.8%和2.0% （P < 0.001）。在多因素分析中，临床肿瘤大小（P < 0.001）、er阴性状态（P < 0.001）和含有紫杉烷（P = 0.01）与pCR独立相关。对于pCR患者，无论ER状态或诱导pCR的方案类型如何，生存率都是相似的。结论：er阳性和er阴性肿瘤患者的pCR率随着治疗方案开始包括紫杉烷并变得更长而增加。这表明，与er阴性肿瘤患者类似，一部分er阳性乳腺癌患者可以从更积极的化疗中获益。
Background: We examined if inclusion of a taxane and more prolonged preoperative chemotherapy improves pathologic complete response (pCR) rate in estrogen receptor (ER)-positive breast cancer compared with three to four courses of 5-fluorouracil, doxorubicin, cyclophosphamide (FAC).Patients and methods: Pooled analysis of results from seven consecutive neo-adjuvant chemotherapy trials including 1079 patients was carried out. These studies were conducted at VID Anderson Cancer Center from 1974 to 2001. Four hundred and twenty-six (39.5%) patients received taxane-based neo-adjuvant therapy. pCR rates and survival times were analyzed as a function of chemotherapy regimen and ER status. Multivariate logistic and Cox regression analysis were carried out to identify variables associated with pCR and survival.Results: Patients with ER-negative cancer had higher overall pCR rate than patients with ER-positive tumors (20.1% versus 4.9%, P < 0.001). In ER-negative patients, the PCR rates were 29% and 15% with and without a taxane (P < 0.001). In ER-positive patients, the pCR rates were 8.8% and 2.0% with and without a taxane (P < 0.001). In multivariate analysis, clinical tumor size (P < 0.001), ER-negative status (P < 0.001) and inclusion of a taxane (P = 0.01) were independently associated with pCR. For patients with pCR, survival was similar regardless of ER status or the type of regimen that induced pCR.Conclusion: pCR rates increased for patients with both ER-positive and ER-negative tumors as regimens started to include a taxane and became longer. This indicates that a subset of patients with ER-positive breast cancer benefits from more aggressive chemotherapy, similarly to patients with ER-negative tumors.