三阴性乳腺癌铂类新辅助化疗证据
将卡铂加入新辅助化疗后，可以显著提高三阴性乳腺癌的病理完全缓解率。不过，由于目前仍然有待前瞻随机对照III期研究数据证实其生存获益，故卡铂尚未成为三阴性乳腺癌的治疗标准。
2018年11月28日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表爱尔兰国立高威大学的回顾研究报告，对三阴性乳腺癌卡铂新辅助化疗的病理完全缓解率与结局以及疗效预测因素进行了回顾分析。
该研究对2000年1月1日～2015年12月31日爱尔兰国立高威大学医院连续333例三阴性乳腺癌患者进行回顾分析。其中，辅助化疗168例（51%）、蒽环类＋紫杉类新辅助化疗97例（29%）、卡铂化疗31例（9%）。
结果，中位随访时间43个月后，乳腺癌复发78例（25%），死于乳腺癌68例（22%）。
接受与未接受卡铂治疗的患者相比：
乳腺病理完全缓解率显著较高：58%比36%（P=0.041）
乳腺腋窝病理完全缓解率显著较高：55%比28%（P=0.011）
根据多因素分析，卡铂和肿瘤分级高是乳腺腋窝病理完全缓解的独立预测因素：
卡铂化疗与否相比：非病理完全缓解率低83%（比值比：0.17，95%置信区间：0.06～0.54，P=0.002）
肿瘤分级高低相比：非病理完全缓解率低95%（比值比：0.05，95%置信区间：0.01～0.27，P<0.001）
乳腺腋窝病理完全缓解是无病生存、无转移生存、乳腺癌相关生存的独立预测因素，非病理完全缓解与病理完全缓解相比：
复发或死亡风险高6.23倍（风险比：6.23，95%置信区间：1.36～28.50，P=0.018）
转移或死亡风险高5.08倍（风险比：5.08，95%置信区间：1.09～23.65，P=0.038）
乳腺癌致死风险高8.52倍（风险比：8.52，95%置信区间：1.09～66.64，P=0.041）
因此，该回顾研究结果表明，卡铂治疗和肿瘤分级高，与病理完全缓解率显著提高相关，而病理完全缓解率又是生存结局的独立预测因素。这些证据可以支持卡铂用于三阴性乳腺癌新辅助化疗，并有待于前瞻随机对照III期研究结果证实。
Breast Cancer Res Treat. 2018 Nov 28.
Outcome for triple negative breast cancer in a retrospective cohort with an emphasis on response to platinum-based neoadjuvant therapy.
Elaine M. Walsh, Aliaa Shalaby, Mark O'Loughlin, Nessa Keane, Mark J Webber, Michael J. Kerin, Maccon M. Keane, Sharon A. Glynn, Grace M. Callagy.
Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; University Hospital Galway, Galway, Ireland.
PURPOSE: The rate of pathological complete response (pCR) for patients with triple negative breast cancer (TNBC) is increased when carboplatin is added to neo-adjuvant chemotherapy (NACT). However, while phase III trial data showing a survival benefit are awaited, carboplatin is not yet standard-of-care for TNBC. The aim of this study was to examine the rate of pCR and the outcome for those treated with carboplatin and to examine the predictors of response to therapy.
METHODS: The retrospective series comprised 333 consecutive patients with TNBC (median follow-up time, 43 months). Adjuvant chemotherapy was given to 51% (n = 168) of patients and 29% (n = 97) received anthracycline-taxane NACT with carboplatin given to 9% (n = 31) of patients.
RESULTS: Overall, 25% (n = 78) of patients experienced a breast cancer recurrence and 22% (n = 68) died from disease. A pCR breast and pCR breast/axilla was more common in those who received carboplatin (n = 18, 58% and n = 17, 55%, respectively) compared those who did not (n = 23, 36% and n = 18, 28%, respectively) (p = 0.041 and p = 0.011, respectively). By multivariable analysis, carboplatin and high tumor grade were independent predictors of pCR breast/axilla (ORnon-pCR = 0.17; 95% CI 0.06-0.54; p = 0.002; and ORnon-pCR = 0.05, 95% CI 0.01-0.27; p < 0.001, respectively). pCR breast/axilla was an independent predictor of DFS (HRnon-pCR=6.23; 95% CI 1.36-28.50; p = 0.018), metastasis-free survival (HRnon-pCR = 5.08; 95% CI 1.09-23.65; p = 0.038) and BCSS (HRnon-pCR = 8.52; 95% CI 1.09-66.64; p = 0.041).
CONCLUSION: Carboplatin therapy and high tumor grade are associated with a significant increase in the rate of pCR, which is an independent predictor of outcome. These data support the use of carboplatin in NACT for TNBC, while results from phase III studies are awaited.
KEYWORDS: Triple negative Breast cancer Survival Pathological complete response Neoadjuvant Carboplatin
DOI: 10.1007/s10549-018-5066-6
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