Long-term results of combined and complex treatment of patients with locally advanced HER2-positive breast cancer
https://doi.org/10.18027/2224-5057-2017-2-14-18
Abstract
The study included 73 women with stage III HER2-positive locally advanced breast cancer (BC) which received simultaneous chemoradiotherapy in combination with targeted therapy. Patients were stratified into two groups: in the first group patients in the neoadjuvant received concomitant chemoradiotherapy in combination with trastuzumab, in the second group patients were prescribed no targeted therapy. The therapy with trastuzumab appeared to be the most effective. 3-year survival rate in the first group was 85.5%, 73.3% – in the second group, 5-year survival rate was 73.9% and 40.3% respectively (p<0.05). Herewith, disease-free survival was higher in the trastuzumab group, but the difference did not reach statistical significance. 3-year disease-free survival rate in the first group was 71.4%, 47.6% – in the second group, 5-year disease-free survival was 40.9% and 26.0% respectively (p=0.06). In addition, the study analyzed the influence of radical mastectomy surgery on long-term outcomes, and explored the efficacy of different fractionation regimes. The findings led to the conclusion that the combined chemoradiotherapy in combination with targeted therapy is an effective treatment for patients with the HER2-positive locally advanced BC. Provided that this therapy is not inferior to the comprehensive treatment which includes surgery and can be used as an independent method of treatment without surgery and associated complications.
About the Authors
A. S. Belokhvostova
A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Obninsk
Russian Federation
Researcher, Department of Radiation and Surgical Treatment of Thoracic Diseases
Russian Federation
Researcher, Department of Radiation and Surgical Treatment of Thoracic Diseases
Y. A. Ragulin
A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Obninsk
Russian Federation
PhD, Head of the Department of Radiation and Surgical Treatment of Thoracic Diseases
Russian Federation
PhD, Head of the Department of Radiation and Surgical Treatment of Thoracic Diseases
References
1. Torre L.A., Bray F., Siegel R. L. Global Cancer Statustics. CA Cancer J. Clin., 2015, Vol. 65, No. 2, pp. 87–108.
2. Каприн А.Д., Старинский В.В., Петрова Г.В. Состояние онкологической помощи населению России в 2014 г. Москва. 2015. С. 27. [Kaprin A.D., Starinskii V.V., Petrova G.V. Status of cancer care the population of Russia in 2014 in Moscow. 2015, P. 27. (In Russ.)].
3. Chapman C.H., Jagsi R. Postmastectomy radiotherapy after neoadjuvant chemotherapy: A Review of the Evidence. Oncology (Williston Park), 2015, Vol. 29, No. 9, pp. 657–66.
4. Semiglazov V. F., Topuzov E. E., Bavli J. L. et al. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb – IIIa breast cancer. Ann. Oncol., 1994, Vol. 5, No. 7, pp. 591–5.
5. Formenti S.C., Volm M., Skinner K.A. et al. Preoperative twice-weekly paclitaxel with concurrent radiation therapy followed by surgery and postoperative doxorubicin-based chemotherapy in locally advanced breast cancer: a phase I/II trial. J. Clin. Oncol., 2003, Vol. 21, No. 5, pp. 864–70.
6. Bollet M.A., Belin L., Reyal F. et al. Preoperative radio-chemotherapy in early breast cancer patients: long-term results of a phase II trial. Radiother. Oncol., 2012, Vol. 102, No. 1, pp. 82–8.
7. Matuschek C., Bolke E., Roth S. L. et al. Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: results of a multivariate analysis. Strahlenther. Onkol, 2012, Vol. 188, No. 9, pp. 777–81.
8. Lerouge D., Touboul E., Lefranc J.P., Genestie C., Moureau-Zabotto L., Blondon J. Combined chemotherapy and preoperative irradiation for locally advanced noninflammatory breast cancer: updated results in a series of 120 patients. Int. J. Radiat. Oncol. Biol. Phys., 2004, Vol. 59, No. 4, pp. 1062–73.
9. Hickey B. E., Francis D.P., Lehman M. Sequencing of chemotherapy and radiotherapy for early breast cancer. Cochrane Database Syst. Rev., 2013, No. 4, P CD005212.
10. Perez C.A., Graham M. L., Taylor M. E. Management of locally advanced carcinoma of the breast. I. Noninflammatory. Cancer, 1994, Vol. 74, No. 1, pp. 453–65.
11. Hoang B., Reilly R.M., Allen C. Block copolymer micelles target Auger electron radiotherapy to the nucleus of HER2-positive breast cancer cells. Biomacromolecules, 2012, Vol. 13, No. 2, pp. 455–65.
12. Horton J.K., Halle J., Ferraro M. Radiosensitization of Chemotherapy-Refractory, Locally Advanced or Locally Recurrent Breast Cancer With Trastuzumab: A Phase II Trial. Int. J. Radiat. Oncol. Biol. Phys., 2010, Vol. 76, No. 4, pp. 998–1004.
13. Jacob J., Belin L., Gobillion A. et al. Prospective monocentric study of the toxicity and the efficacy of concurrent trastuzumab and radiotherapy. Cancer Radiotherapy, 2013, Vol. 17, No. 3, pp. 183–90.
Review
For citations:
Belokhvostova A.S., Ragulin Y.A. Long-term results of combined and complex treatment of patients with locally advanced HER2-positive breast cancer. Malignant tumours. 2017;(2):14-18. (In Russ.) https://doi.org/10.18027/2224-5057-2017-2-14-18
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