HER2-POZİTİF LOKAL İLERİ MEME KANSERİNDE NEOADJUVAN TRASTUZUMAB SIRALAMASININ PATOLOJİK TAM YANIT ÜZERİNE ETKİSİ The effect of neoadjuvant trastuzumab treatment sequence on pathologic complete response in HER2-positive locally advanced breast cancer
Abstract
Amaç: Trastuzumabın meme kanserinde neoadjuvan tedaviye eklenmesiyle patolojik tam yanıt (PTY) oranını
arttırdığı bilinmektedir. Ancak trastuzumabın kullanım sırasıyla ilgili kısıtlı veri bulunmaktadır. HER2 pozitif
lokal ileri meme kanserinde neoadjuvan trastuzumab uygulama sırasının PTY üzerine etkisi olup olmadığını
incelemeyi amaçladık.
Gereç ve Yöntemler: 2010-2018 yılları arasında HER2 pozitif evre 2 ve 3 meme kanseri nedeniyle neoadjuvan
trastuzumab kullanan hastaların verileri retrospektif incelenmiş olup antrasiklin bazlı tedavi sonrası
trastuzumab alan 30 hasta ve tam tersi sıralama ile tedavi alan 16 hasta çalışmaya alındı.
Bulgular: Çalışmaya toplam 46 hasta alınmış olup ortanca takip süresi 31 aydı (aralık; 7–98). Hastaların ortanca
yaşı 51 yıldı (19–72). Tüm hastaların %52’si postmenopozal, %67'si hormon reseptör pozitifti. Tüm
hastalarda klinik nod pozitifliği olup %54'ü cN1 idi. Hastalar trastuzumab sıralamasına göre grupla ayrıldı.
Bazal özellikler açısından gruplar arasında fark yoktu. PTY oranı trastuzumab ile tedaviye başlayanlarda %63
olup diğer grupta %37 idi (p=0.1). Üç yıllık kümülatif hastalıksız sağ kalım oranları ise sırasıyla %100 ve %80
idi (p=0.2). Tek değişkenli analizde evre 2 ve Vücut kitle indeksi (VKİ) <25 kg/m² olan grupta PTY oranı anlamlı
olarak daha yüksekti. Çok değişkenli analizde ise sadece VKİ <25 kg/m² olmasının bağımsız prediktif faktör
olduğu bulundu (Odds oranı: 18.1; %95 Güven aralığı 1.39–36.0, p=0.03).
Sonuç: Neoadjuvan tedaviye trastuzumab ile başlanması PTY oranını sayısal olarak arttırmış olsa da fark
istatistiksel olarak anlamlı değildi. Farkın istatistiksel olarak anlamlı olmamasının nedeni hasta sayımızın az
olması olabilir. Trastuzumab sıralamasının PTY ile ilişkisine yönelik daha büyük hasta popülasyonuna sahip
prospektif çalışmalara ihtiyaç vardır.
Anahtar sözcükler: Meme kanseri; Neoadjuvan tedavi; Trastuzumab sıralaması; Patolojik tam yanıt
ABSTRACT
Aim: The aim of this study was to investigate the effect of neoadjuvant trastuzumab administration order on
PCR in locally advanced breast cancer.
Material and Method: The data of patients who had recieved neoadjuvant trastuzumab for HER 2 positive
stage 2 and 3 breast cancer between 2010 and 2018 were retrospectively analyzed; 30 patients who firstly
had received anthracycline treatment then trastuzumab and 16 patients who had received in reverse order
included to our study.
Results: A number of 46 patients included study and median follow-up time was 31 months (range;
7–98). The median age of whole group was 51 years (19–72). There was no significant difference in basal
characteristics when the patients were grouped according to the order of trastuzumab. PCR rates were 63%
in patients whose treatment had started with trastuzumab, 37% in the other group (p=0.1) and the 3-year
cumulative disease-free survival rates were 100% and 80%, respectively (p=0.2). In the univariate analysis,
the PCR ratio was significantly higher in the stage 2 and BMI<25 kg/m² group; in multivariate analysis,
only having a BMI<25 kg / m² was found to be an independent predictive factor (Odds ratio: 18.1; 95% CI
1.39–36.0, p=0.03).
Conclusion: Although starting neoadjuvant therapy with trastuzumab increased the rate of PCR numerically,
the difference was not statistically significant. The reason of not reaching statistical significance may be the
insufficient number of patients. Prospective trials are needed to assign the treatment sequence that may
affect PCR.
Keywords: Breast cancer; Neoadjuvant treatment; Trastuzumab sequencing; Pathologic complete response
References
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Abstract
References
- 1. Fitzmaurice C, Akinyemiju TF, Al Lami FH, Alam T, Alizadeh-Navaei R, Allen C et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2018;4(11):1553-68. 2. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188-94. 3. Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J et al. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27-39. 4. Buzdar AU. Preoperative chemotherapy treatment of breast cancer--a review. Cancer. 2007;110(11):2394-407. 5. Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G et al. Preoperative ther apy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008;26(5):814-19. 6. Buzdar AU, Suman VJ, Meric-Bernstam F, Leitch AM, Ellis MJ, Boughey JC et al. Fluorouracil, epirubicin, and cyclophosphamide (FEC-75) followed by paclitaxel plus trastuzumab versus paclitaxel plus trastuzumab followed by FEC-75 plus trastuzumab as neoadjuvant treatment for patients with HER2-positive breast cancer (Z1041): a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14(13):1317-25. 7. Chang HR. Trastuzumab-based neoadjuvant therapy in patients with HER2-positive breast cancer. Cancer. 2010;116(12):2856-67. 8. Cronin KA, Harlan LC, Dodd KW, Abrams JS, Ballard-Barbash R. Population-based Estimate of the Prevalence of HER-2 Positive Breast Cancer Tumors for Early Stage Patients in the US. Cancer Invest. 2010;28(9):963-8. 9. Viani GA, Afonso SL, Stefano EJ, De Fendi LI, Soares FV. Adjuvant trastuzumab in the treatment of her-2-positive early breast cancer: a meta-analysis of published randomized trials. BMC Cancer. 2007;7:153. 10. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353(16):1673-84.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | June 8, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 2 |