SABCS 2015:化疗对Luminal A型乳腺癌无益?!附评论(圣安东尼奥乳癌研讨会)

2015-12-10 Seven L 译 MedSci原创

对以前的Danish研究的最新分析表明,绝经前女性患Luminal A 型乳腺癌(一种常见的固有亚型),就算淋巴结已转移,可以完全不使用化疗,也能有较好预后!加拿大英属哥伦比亚大学的Torsten Nielsen在正在举行的圣安东尼奥乳腺癌研讨会上报道了数据分析结果,引起了一些非议,毕竟化疗对于绝经前乳腺癌女性是标准治疗方案。圣安东尼奥德克萨斯大学健康科学中心的Virginia Kaklamani

对以前的Danish研究的最新分析表明,绝经前女性患Luminal A 型乳腺癌(一种常见的固有亚型),就算淋巴结已转移,仍可完全不使用化疗,也能有较好预后!

加拿大英属哥伦比亚大学的Torsten Nielsen在正在举行的圣安东尼奥乳腺癌研讨会上报道了数据分析结果,引起了一些非议,毕竟化疗对于绝经前乳腺癌女性是标准治疗方案。圣安东尼奥德克萨斯大学健康科学中心的Virginia Kaklamani提到:“分析结果与我们正在进行的前瞻性研究结果相似,也验证了我们的想法——对该类患者不需要化疗!”

Dr Kaklamani说:“该结果给了我一些信心,对绝经前乳腺癌女性不进行化疗。实践中对激素受体阴性、至少55岁或60岁的女性乳腺癌患者,不进行化疗;但是对绝经前女性我们未曾想过。”

以前的Danish研究纳入了1146名肿瘤直径>5cm或腋窝淋巴结转移的乳腺癌患者(不管激素受体或HER2情况),将其随机分为口服环磷酰胺(C)或环磷酰胺+甲氨蝶呤+5-氟尿嘧啶(CMF)或非化疗治疗(左旋咪唑或安慰剂)。

研究数据显示10年无病生存 (DFS)在化疗人群(C 55.5%,CMF 48.8%)中优于非化疗人群(左旋咪唑 35.2%,安慰剂 38.6%)。结合免疫组化结果表明,化疗改善了468例非Luminal A型乳腺癌患者的DFS(HR 0.50),但是对165例Luminal A型乳腺癌患者的DFS没有益处(HR 1.07, P < .05)。

 Dr Kaklamani说:“本研究的局限性之一是化疗没有包括蒽环霉素或紫杉烷类。”

纪念斯隆凯特林癌症中心的Steve Sugarman提问:“这是否意味着对于未进行内分泌治疗的Luminal A型乳腺癌患者,CMF化疗方案一点用都没有?”Dr Nielsen回答:“是那样的。我们真的在努力解决化疗还是不化疗这个问题,很难找到一项关于蒽环霉素或紫杉烷与什么都不使用的随机试验。”

另一名临床医生对分析结果无动于衷。纽约私人诊所肿瘤学家Steven Vogl说:“仅仅31名Luminal A型患者没有接受化疗,一项小样本的老研究并不能说明什么。”

西班牙巴塞罗那大学医院诊所的Aleix Prat说:“这些研究结果填补一个缺口,关于通过乳腺癌亚型预测化疗效益。这是第一个根据亚型评估化疗效果的研究。”

Dr Prat说:“在许多国家,特别是在欧洲,免疫组织化学技术作为一个预后指标已经被广泛使用,该项分析表明,亚型在临床上的应用价值更大!”

“这项新研究的结果告诉我们,亚型不仅可以评估预后,还能预测化疗效果!这些结果将有助于我们更好地识别这些患者该不该进行化疗。并不是因为不用化疗复发风险低,而是化疗对其无益!”

“未来的研究应重点集中在目前常用化疗药物如紫杉烷和蒽环霉素;还有通过基因表达对其分型预测化疗结局是否会优于基于免疫组化的分类。”

原始出处:

San Antonio Breast Cancer Symposium 2015: Abstract S1-08. Presented December 9, 2015.

Skip Chemo in Young Women With Common Breast Cancer Subtype?Medscape.Dec,2015


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    2016-07-01 kcb069
  3. [GetPortalCommentsPageByObjectIdResponse(id=1777042, encodeId=e1fc1e77042a7, content=<a href='/topic/show?id=45ae1e1830' target=_blank style='color:#2F92EE;'>#ABC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1718, encryptionId=45ae1e1830, topicName=ABC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a54039078223, createdName=cmj21wellington, createdTime=Wed Jun 08 02:27:00 CST 2016, time=2016-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1994700, encodeId=852e1994e00df, content=<a href='/topic/show?id=3d51e345936' target=_blank style='color:#2F92EE;'>#研讨会#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73459, encryptionId=3d51e345936, topicName=研讨会)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Jul 01 11:27:00 CST 2016, time=2016-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48548, encodeId=9497485483c, content=好文章,值得看。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 17:27:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=45813, encodeId=098f4581342, content=…………, beContent=null, objectType=article, channel=null, level=null, likeNumber=160, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=554a1670659, createdName=yuwenpsy, createdTime=Sun Dec 13 22:35:00 CST 2015, time=2015-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1587492, encodeId=4983158e49263, content=<a href='/topic/show?id=e03515826f8' target=_blank style='color:#2F92EE;'>#SABCS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15826, encryptionId=e03515826f8, topicName=SABCS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=826117479684, createdName=guguangxiang, createdTime=Sat Dec 12 12:27:00 CST 2015, time=2015-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=45635, encodeId=5e5045635b8, content=科学要再进一步啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dd261670317, createdName=科研小旋风, createdTime=Fri Dec 11 23:33:00 CST 2015, time=2015-12-11, status=1, ipAttribution=)]
    2015-12-26 hixiaoluo

    好文章,值得看。

    0

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    2015-12-13 yuwenpsy

    …………

    0

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    2015-12-11 科研小旋风

    科学要再进一步啊

    0

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