|
对于早期乳腺癌，曲妥珠单抗的维持时间已有定论。对于晚期、转移性乳腺癌，曲妥珠单抗的维持时间尚不明确。 2017年10月11日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表土耳其詹卡亚大学乳腺癌临床中心的评论：HER2阳性转移性乳腺癌完全缓解后的曲妥珠单抗维持时间仍有争议？ 一个月前，日本学者在该刊发表研究报告，回顾评估了被诊断为HER2阳性转移性乳腺癌患者接受曲妥珠单抗一线治疗超过2年的数据。据该研究报告，一些患者中断曲妥珠单抗治疗后未见任何疾病复发证据。作者还表示，是否停止曲妥珠单抗维持治疗的决策，对于该患者人群是非常关键的问题。停止曲妥珠单抗维持治疗之前，应该确定患者和肿瘤的有利特征。HER2阳性转移性乳腺癌患者亚组，尤其激素受体阴性、HER2高表达者和HER2受体结构完整者，预计对曲妥珠单抗更敏感，可能不是停用曲妥珠单抗的良好候选者。文中一些病例报告描述了曲妥珠单抗停止后的症状快速发作，证实曲妥珠单抗撤药可能改变该疾病生物学及其与宿主复杂相互作用的理论。一线治疗获得完全缓解的HER2阳性患者，应该开展随机研究，对继续观察或继续维持曲妥珠单抗的客观有效性进行比较。不过，对于此类患者是否停用曲妥珠单抗的决策仍然很有争议。 前情提要 虽然晚期和转移性HER2阳性乳腺癌无法治愈，但是一小部分HER2阳性转移性乳腺癌患者抗HER2治疗后仍然获得持久完全缓解。因此，有些学者假设某些HER2阳性转移性乳腺癌病例可能治愈。 2017年9月11日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表神奈川东海大学、国家癌症中心、圣路加国际医院、名古屋爱知癌症中心医院、大阪国立医院、群马县立癌症中心、北海道癌症中心、静冈综合医院、鹿儿岛萨加拉医院、静冈癌症中心、东京医疗中心、冈山大学医院、四国癌症中心、福岛医科大学的大型多中心回顾研究报告，对HER2阳性转移性乳腺癌患者曲妥珠单抗一线治疗后持久完全缓解的长期结局进行了评定。 该研究对2001年4月1日～2014年12月31日在日本临床肿瘤学组乳腺癌研究协作组下属19个机构被诊断为HER2阳性转移性乳腺癌患者接受曲妥珠单抗一线治疗2年以上的数据进行回顾分析。初步入选124例患者，排除其中16例（13例无进展生存少于2年、3例缺少生存数据），对其余108例进行评估。 结果发现，经过中位随访7.7年：
曲妥珠单抗治疗中断27例（47.4%）：
因此，该研究表明，曲妥珠单抗治疗中断后，不少患者并无任何疾病进展证据。对于该患者人群，应该对有限时间内停止曲妥珠单抗维持治疗进行谨慎探讨，同时等待全球合作努力进行随机研究。 Breast Cancer Res Treat. 2017 Oct 11. [Epub ahead of print] Duration of trastuzumab in HER2-positive metastatic breast cancer after complete remission: still debatable issue? Kadri Altundag. MKA Breast Cancer Clinic, Cankaya, Turkey. Dear Editor, I wish to congratulate Niikura and colleagues for their article [1] in which they retrospectively evaluated the data of patients diagnosed with HER2-positive metastatic breast cancer who received trastuzumab for more than 2 years as the first-line treatment. They reported that some patients showed no evidence of disease after the interruption of trastuzumab therapy. As authors also stated that decision to discontinuation of maintenance, trastuzumab in this patient population is very critical issue. Favorable characteristics patients and tumor should be determined before stopping trastuzumab maintenance treatment. A subgroup of patients with HER2-positive metastatic breast cancer, especially those with hormone receptor negative and truly HER2-enriched subtype and those with a structurally intact HER2 receptor who are expected be more sensitive to trastuzumab might not be good candidates for discontinuation of trastuzumab. Some case reports in the literature describe the rapid onset of symptoms soon after cessation of trastuzumab which supports the theory that the withdrawal of trastuzumab might have altered the biology of the disease and its complex interactions with the host. The objective efficacy of prolonged maintenance of trastuzumab compared with observation in HER2-positive patients achieving complete response to first-line treatment should be tested in randomized trials. However, the decision of whether trastuzumab should be discontinued or not in such patients remains strongly controversial [2,3]. REFERENCES
DOI: 10.1007/s10549-017-4536-6 Breast Cancer Res Treat. 2017 Sep 11. [Epub ahead of print] Durable complete response in HER2-positive breast cancer: a multicenter retrospective analysis. Niikura N, Shimomura A, Fukatsu Y, Sawaki M, Ogiya R, Yasojima H, Fujisawa T, Yamamoto M, Tsuneizumi M, Kitani A, Watanabe J, Matsui A, Takahashi Y, Takashima S, Shien T, Tamura K, Saji S, Masuda N, Tokuda Y, Iwata H. Tokai University School of Medicine, Kanagawa, Japan; National Cancer Center, Tokyo, Japan; St. Luke's International Hospital, Tokyo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Gunma, Japan; Hokkaido Cancer Center, Sapporo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sagara Hospital, Kagoshima, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Okayama University Hospital, Okayama, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; Fukushima Medical University, Fukushima, Japan. PURPOSE: Though advanced and metastatic epidermal growth factor receptor 2 (HER2)-positive disease is not curable, a small proportion of patients with HER2-positive metastatic breast cancer remain in prolonged complete remission with anti-HER2 treatment. We hypothesized that some cases of HER2-positive metastatic breast cancer may be curable. In this large, multicenter retrospective study, we aimed to assess the long-term outcomes for patients with a durable response to trastuzumab. METHODS: We retrospectively evaluated the data of patients diagnosed with HER2-positive metastatic breast cancer who received trastuzumab for more than 2 years as the first-line treatment. Patients diagnosed between April 1, 2001 and December 31, 2014 at 19 institutions in Japan were included in the analysis. From 124 potential subjects, 16 were excluded and 108 were evaluated. RESULTS: The median follow-up length was 7.7 years. Disease progression occurred in 44/108 (40.7%) patients and 13/108 (12%) patients died. The median progression-free survival was 11.2 years, and as more than 80% of patients were alive 10 years after metastatic breast cancer diagnosis. Of the 108 patients, 57 achieved a clinical complete response. Trastuzumab therapy was interrupted for 27 (47.4%) of these patients (based on the doctor's recommendation for 19 patients, owing to adverse events for 4 patients, owing to unknown reasons for 3 patients, and at the request of 1 patient). Disease progression occurred in 4 of the 27 patients after the interruption of trastuzumab treatment. The median duration of trastuzumab therapy for all 27 patients was 5.1 years (0.9-9.3 years). CONCLUSION: We found that some patients showed no evidence of disease after the interruption of trastuzumab therapy. Discontinuation of maintenance trastuzumab in this patient population after a limited time should be explored cautiously while awaiting a global collaborative effort for a randomized trial. KEYWORDS: Breast cancer; Durable complete response; HER2 positive; Trastuzumab PMID: 28895005 DOI: 10.1007/s10549-017-4489-9 |
|
|
