JCO:HER2双重靶向治疗显著改善乳腺癌患者预后

2020-10-24 星云 MedSci原创

CALGB 40601试验旨在评估在新辅助化疗中使用双药和单药靶向人表皮生长因子受体2(HER2)是否可提高病理完全缓解(pCR)。本次报告分析了无复发生存率(RFS)和总生存率(OS),以及预测pC

CALGB 40601试验旨在评估在新辅助化疗中使用双药和单药靶向人表皮生长因子受体2(HER2)是否可提高病理完全缓解(pCR)。本次报告分析了无复发生存率(RFS)和总生存率(OS),以及预测pCR和生存率的基因表达签名。

在CALGB 40601试验中,350名未治疗过的II-III期HER2阳性乳腺癌患者被随机分至三组,分别接受紫杉醇联合曲妥珠单抗+拉帕替尼(THL)、紫杉醇联合曲妥单抗(TH)或紫杉醇联合拉帕替尼(TL)治疗。主要终点是pCR,次要结点包括RFS、OS和基因表达分析。并对264例预处理样本进行了mRNA测序。

180位患者被分至THL组,120位分至TH组和67位分至TL组。随访超过7年后,THL组患者的RFS和OS明显优于TH组(RFS风险比 0.32;OS风险比 0.34),TH组和TL组之间无明显差异。在688例既往描述过的基因表达签名中,有215个在本次分析中与pCR相关,45个月RFS相关,只有22个同时与pCR和RFS相关(3.2%)。具体而言,8个免疫特征与较高的pCR率和较好的RFS显著相关。在残留病灶阳性患者中,免疫球蛋白G特征是一个独立的良好预后因子,而与较高的pCR率相关的HER2富集特征与RFS显著缩短相关。

在CALGB 40601试验中,双重靶向HER2治疗可明显提高RFS和OS。综合内在亚型和免疫标记特征使得pCR和RFS的预测成为可能,无论是总体上还是残留疾病组。该研究或可指导合理的升降HER2阳性乳腺癌的的治疗策略。

原始出处:

Aranzazu Fernandez-Martinez, et al. Survival, Pathologic Response, and Genomics in CALGB 40601 (Alliance), a Neoadjuvant Phase III Trial of Paclitaxel-Trastuzumab With or Without Lapatinib in HER2-Positive Breast Cancer. Journal of Clinical Oncology. October 23, 2020.

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    2021-02-20 lidong40
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    2020-10-28 12580cecm96暂无昵称

    双靶由双妥改成曲妥珠单抗加拉帕替尼可以减轻患者的负担

    0

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    2020-10-25 lovetcm

    现在HER2+#乳腺癌#标准采用双妥方案了:曲妥珠+帕妥珠

    0

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    2020-10-25 ms9000000764791279

    很有见地

    0

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