期刊
BREAST CANCER RESEARCH AND TREATMENT
卷 158, 期 3, 页码 485-495出版社
SPRINGER
DOI: 10.1007/s10549-016-3889-6
关键词
Breast cancer; Locally advanced; Inflammatory; Bevacizumab; Neoadjuvant
类别
资金
- National Institutes of Health (NIH)/National Cancer Institute (NCI)/National Clinical Trials Network (NCTN) [CA180888, CA180819, CA180821, CA180835, CA180830, CA180846, CA180801, CA180834]
- NIH/NCI Community Oncology Research Program (NCORP) [CA189954, CA189856, CA189971, CA189822, CA189952, CA189804, CA189817, CA189953, CA189858, CA189957, CA189872, CA189853]
- NIH/NCI [CA35119, CA52654, CA04919, CA37981, CA58416, CA16385]
- Genentech (Roche)
- Abraxis BioScience (Celgene)
- Helomics(TM)
SWOG S0800, a randomized open-label Phase II clinical trial, compared the combination of weekly nab-paclitaxel and bevacizumab followed by dose-dense doxorubicin and cyclophosphamide (AC) with nab-paclitaxel followed or preceded by AC as neoadjuvant treatment for HER2-negative locally advanced breast cancer (LABC) or inflammatory breast cancer (IBC). Patients were randomly allocated (2:1:1) to three neoadjuvant chemotherapy arms: (1) nab-paclitaxel with concurrent bevacizumab followed by AC; (2) nab-paclitaxel followed by AC; or (3) AC followed by nab-paclitaxel. The primary endpoint was pathologic complete response (pCR) with stratification by disease type (non-IBC LABC vs. IBC) and hormone receptor status (positive vs. negative). Overall survival (OS), event-free survival (EFS), and toxicity were secondary endpoints. Analyses were intent-to-treat comparing bevacizumab to the combined control arms. A total of 215 patients were accrued including 11 % with IBC and 32 % with triple-negative breast cancer (TNBC). The addition of bevacizumab significantly increased the pCR rate overall (36 vs. 21 %; p = 0.019) and in TNBC (59 vs. 29 %; p = 0.014), but not in hormone receptor-positive disease (24 vs. 18 %; p = 0.41). Sequence of administration of nab-paclitaxel and AC did not affect the pCR rate. While no significant differences in OS or EFS were seen, a trend favored the addition of bevacizumab for EFS (p = 0.06) in TNBC. Overall, Grade 3-4 adverse events did not differ substantially by treatment arm. The addition of bevacizumab to nab-paclitaxel prior to dose-dense AC neoadjuvant chemotherapy significantly improved the pCR rate compared to chemotherapy alone in patients with triple-negative LABC/IBC and was accompanied by a trend for improved EFS. This suggests reconsideration of the role of bevacizumab in high-risk triple-negative locally advanced breast cancer.
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