术前内分泌治疗与术前化疗的比较

　　虽然术前新辅助化疗已被确立为适用于局部晚期乳腺癌患者的治疗标准，但是对于雌激素受体阳性HER2阴性乳腺癌女性，术前新辅助内分泌治疗已被重新关注。虽然已知术前新辅助内分泌治疗的病理完全缓解率较低，但是关于降低分期和长期结局的数据存在分歧。

　　2019年6月10日，爱思唯尔旗下《临床乳腺癌》在线发表加拿大温哥华癌症中心、滑铁卢大学、不列颠哥伦比亚大学、美国耶鲁大学的研究报告，比较了术前新辅助内分泌治疗与术前新辅助化疗对雌激素受体阳性乳腺癌的效果。

　　该研究通过温哥华癌症中心前瞻数据库，对2012～2017年雌激素受体阳性HER2阴性乳腺癌术前新辅助治疗患者进行回顾分析。经过年龄、分期、分级匹配，对术前新辅助内分泌治疗患者与术前新辅助化疗患者的分期降低、病理完全缓解、保乳手术、临床病理分期＋雌激素受体和细胞核分级评分进行比较。

　　结果，176例患者符合分析条件，其中术前新辅助化疗111例（63%）、术前新辅助内分泌治疗51例（29%）、两者序贯14例（8%）。

　　术前新辅助内分泌治疗的中位持续时间为90天。术前新辅助内分泌治疗女性与其他女性相比

• 年龄较大（中位65.5比51.2岁，P<0.0001）

• 分期较低（P<0.0001）

　　经过匹配，术前新辅助化疗与术前新辅助内分泌治疗相比：

• 临床分期降低比例较高（39%比22%，P=0.032）

• 病理完全缓解比例相同（2%比2%）

• 保乳手术转换比例较低（8%比13%，P=0.70）

• 临床病理分期＋雌激素受体和细胞核分级评分相似

　　因此，该研究结果表明，对于雌激素受体阳性HER2阴性乳腺癌患者，经过年龄、分期、分级匹配，术前新辅助化疗与术前新辅助内分泌治疗相比，可以显著提高临床分期降低比例。该研究强调了明确肿瘤生物学特征的重要性以及生物学标志的必要性，可以作为治疗告知的预测工具。

Clin Breast Cancer. 2019 Jun 10. [Epub ahead of print]

Efficacy of Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in ER-positive Breast Cancer: Results from a Prospective Institutional Database.

Nathalie LeVasseur, Kaylie-Anne Willemsma, Huaqi Li, Lovedeep Gondara, Walter C. Yip, Caroline Illmann, Stephen K. Chia, Christine Simmons.

British Columbia Cancer Agency, Vancouver, Canada; University of Waterloo, Waterloo, Canada; Yale University, New Haven, United States; University of British Columbia, Vancouver, Canada.

BACKGROUND: While neoadjuvant chemotherapy (NACT) has been established as a standard for medically fit patients with locally advanced breast cancer, there has been renewed interest in utilizing neoadjuvant endocrine therapy (NET) for women with estrogen-receptor (ER) positive, HER2 negative breast cancer. Rates of pCR are known to be low, but data regarding down-staging and long-term outcomes are inconsistent.

METHODS: A prospective institutional database of breast cancer patients treated with neoadjuvant therapy from 2012-2017 was analyzed to identify patients with ER positive, HER2 negative breast cancer. Patients who received NET were compared to those who received NACT. A matched analysis (age, stage, grade) was performed to compare rates of down-staging, pCR, breast conserving surgery (BCS) and CPS+EG scores.

RESULTS: 176 patients met eligibility criteria. 111 patients (63%) received NACT, 51 (29%) received NET and 14 (8%) received both sequentially. Women prescribed NET were older (65.5 vs 51.2y, p<0.0001) and presented with lower clinical stage (p<0.0001). Median duration of NET was 90 days. When matched, clinical down-staging was more frequent with NACT (20/51, 39%) compared to NET (11/51, 22%), p=0.032. Of these, 2% achieved pCR in each cohort. Conversion rates to BCS eligible were low (8% and 13% with NET and NACT; p=0.70). No significant differences in CPS+EG scores were identified.

CONCLUSIONS: Significantly higher rates of down-staging were achieved with NACT compared to NET when patients were matched. This study highlights the importance of establishing tumor biology and the need for biomarkers that can be used as predictive tools to inform treatment.

KEYWORDS: breast tumour, pre-operative endocrine therapy, pre-operative chemotherapy, pathologic complete response

DOI: 10.1016/j.clbc.2019.05.020