Anthracycline-Free Neoadjuvant Chemotherapy Ensures Higher Rates of Pathologic Complete Response in Breast Cancer
Anthracycline-Free Neoadjuvant Chemotherapy Ensures Higher Rates of Pathologic Complete Response in Breast Cancer
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DOI：
10.1016/j.clbc.2016.06.010
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发表时间：
2017-02-01
影响因子：
3.1
通讯作者：
Scarpa, Susanna
中科院分区：
文献类型：
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作者：
De Iuliis, Francesca;Salerno, Gerardo;Scarpa, Susanna
我们描述了一项对最初不能手术的乳腺癌患者进行的基于不含蒽环类紫杉烷/卡铂的新辅助化疗的研究。病理完全缓解的主要终点为%，耐受性高，无4级毒性。目的：新辅助化疗(NCT)是治疗局部晚期、初期不能手术的乳腺癌的标准治疗方案。NCT可以测试化疗效果，随后可以进行保乳手术。考虑到紫杉烷类药物是最有效的药物之一，我们分析了不含蒽环类药物，仅基于紫杉烷和卡铂的新辅助方案的疗效，试图避免心脏毒性，这是与蒽环类药物相关的最严重的副作用。患者和方法：我们登记了61例乳腺癌患者，根据分子表型分为4个亚型：三阴性/基底样型24例，HER2样型13例，腔型B型20例，腔型A型4例。所有患者每周接受卡铂AUC2，紫杉醇80 mg/m(2)，曲妥珠单抗(HER2阳性)2 mg/kg的化疗，除腔型A患者仅接受激素治疗外。在61例患者中，26例(43%)接受了改良根治术，35例(57%)接受了保乳手术。结果：24例三阴性/基底细胞样中20例(83%)病理完全缓解，13例HER2样中10例(76%)，20例B腔中6例(30%)，4例A腔中3例(75%)。所有患者均经毒性评估：无4级，5例出现3级神经病变，停药后转为G2级。至少随访5年，中位总生存期为48个月。结论：紫杉烷/卡铂/不含蒽环类药物的NCT是治疗不能手术的乳腺癌的最佳方案，该方案避免了心脏毒性，获得了最佳的PCR率(%)，对生存有重要影响。
We describe a study of anthracycline-free taxane/carboplatin-based neoadjuvant chemotherapy in patients with initially inoperable breast cancer. The primary endpoint of pathologic complete response was 64% with a high tolerability and no grade 4 toxicity. Therefore, we propose this schedule of therapy as the best in terms of efficacy and low toxicity for this kind of patient.Purpose: Neoadjuvant chemotherapy (NCT) is a standard of care for locally advanced and initially inoperable breast cancer. NCT can test chemotherapy efficacy and can be followed by breast-conserving surgery. Considering taxanes as one of the most effective agents, we analyzed the efficacy of a neoadjuvant schedule without anthracyclines and based only on taxanes and carboplatin, trying to avoid cardiotoxicity, which is the most serious side effect correlated with anthracyclines. Patients and Methods: We enrolled 61 patients with breast cancer, belonging to 4 subgroups, according to molecular phenotypes: 24 triple-negative/basal-like, 13 HER2-like, 20 luminal B, and 4 luminal A. All patients underwent weekly chemotherapy with carboplatin AUC2, paclitaxel 80 mg/m(2), with trastuzumab (in case of HER2 positivity) 2 mg/kg, except for luminal A patients, who underwent only hormonal therapy. Among 61 patients, 26 (43%) received modified radical mastectomy and 35 (57%) received breast-conserving surgery. Results: The patients obtaining pathologic complete response (pCR) were 20 (83%) of 24 triple-negative/basal-like, 10 (76%) of 13 HER2-like, 6 (30%) of 20 luminal B, and 3 (75%) of 4 luminal A. All the patients were evaluated for toxicity: no grade 4 was detected, 5 patients experienced grade 3 neuropathy, then reverted to G2 after chemotherapy discontinuation. At a minimum follow-up of 5 years, median overall survival was 48 months. Conclusion: Taxane/carboplatin-based/anthracycline-free NCT is the best treatment for inoperable breast cancer in terms of efficacy and toxicity, because this approach avoids cardiotoxicity and obtains an optimal rate (64%) of pCR, with an important impact on survival.