Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel
Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel
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DOI：
10.1007/s00280-007-0652-z
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发表时间：
2008-09-01
影响因子：
3
通讯作者：
Colleoni, Marco
中科院分区：
文献类型：
--
作者：
Torrisi, Rosalba;Balduzzi, Alessandra;Colleoni, Marco
背景对于三阴性乳腺癌没有特定的治疗指南，三阴性乳腺癌的定义是缺乏雌激素（ER）、孕激素（PgR）和HER 2受体的表达。PgR < 10%和HER 2阴性乳腺癌在病理学方面的活性（pCR）4个疗程的顺铂化疗（ECF、表阿霉素、顺铂和氟尿嘧啶连续输注），随后3个疗程的紫杉醇每周治疗的客观反应。采用环磷酰胺、甲氨蝶呤等辅助节拍化疗4-6个月。中位年龄为41岁（28-64岁）。23/25例可评价肿瘤表皮生长因子受体染色阳性。在26例患者中观察到完全或部分客观缓解（86，95% CI 69.3-96.2%）。12例患者获得pCR（40，95% CI 22.7-59.4%）。2例患者在紫杉醇治疗期间发生进展。80%（95% CI 61.4-92.3%）的患者在手术时发现腋淋巴结阴性。26例患者（86，95% CI 61.4-92.3%）接受了保乳手术。在ECF和紫杉醇治疗期间，分别在3名和2名患者中观察到> 2级非血液学毒性。2年无病生存率（DFS）为87.5%（95% CI 74.7 ~ 100%）。EGFR染色和pCR或DFS之间没有显着的相关性观察。结论术前顺铂化疗后紫杉醇诱导高pCR率在三阴性乳腺癌的人口。该时间表对长期结局的影响应在更大的系列中进行研究。
Background No specific treatment guidelines are available for triple-negative breast cancers, defined by a lack of expression of estrogen (ER), progesterone (PgR), and HER2 receptors.Patients and methods We investigated in patients with T2-T3 N0-3 ER, PgR < 10% and HER2 negative breast cancers the activity both in terms of pathological (pCR) and objective responses of four courses of cisplatin containing chemotherapy (ECF, epirubicin, cisplatin, and fluorouracil as continuous infusion) followed by three courses of weekly paclitaxel. Adjuvant metronomic chemotherapy including cyclophosphamide and methotrexate for 4-6 months was administered.Results Thirty patients are evaluable. Median age was 41 years (28-64 years). Twenty-three of 25 evaluable tumors stained positively for epidermal growth factor receptor. An objective response, either complete and partial, was observed in 26 patients (86, 95% CI 69.3-96.2%). and a pCR was obtained in 12 patients (40, 95% CI 22.7-59.4%). Two patients progressed during paclitaxel. Negative axillary nodes were found in 80% (95% CI 61.4-92.3%) of patients at surgery. Twenty-six patients (86, 95% CI 61.4-92.3%) underwent breast conserving surgery. Grade > 2 non-hematological toxicity was observed in three and two patients during ECF and paclitaxel, respectively. The 2-year disease free survival (DFS) was 87.5% (95% CI 74.7-100%). No significant correlation was observed between EGFR staining and either pCR or DFS.Conclusions Preoperative cisplatin containing chemotherapy followed by paclitaxel induced an high pCR rate in a population of triple-negative breast cancer. The impact of this schedule on long-term outcome should be investigated in larger series.