期刊
ECLINICALMEDICINE
卷 28, 期 -, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.eclinm.2020.100566
关键词
Her-2 positive breast cancer; Bevacizumab; Neoadjuvant; Positron emission tomography; Early pet assessment; Delta suvmax; pathological complete response; Long-term follow-up
资金
- Roche France
Background: The open-label, randomised Phase 2 AVATAXHER study (NCT01142778) demonstrated that early PET assessment identified HER2-positive breast cancer patients who responded poorly to neoadjuvant docetaxel plus trastuzumab. Adding neoadjuvant bevacizumab for PET-predicted poor-responders improved pathological complete response (pCR) rates (43.8% vs 24.0%). We investigated long-term study outcomes. Methods: Patients were treated in three groups. All patients initially received two cycles of standard neoadjuvant therapy with [F-18]-FDG PET conducted before each cycle. Those with >= 70% change in the maximum standardised uptake value (Delta SUVmax) received four further cycles of standard neoadjuvant therapy (PET responders). PET-predicted poor-responders (Delta SUVmax <70%) were randomised (2:1) to neoadjuvant therapy with (Group A) or without (Group B) bevacizumab for cycles 3-6. All patients received one further cycle of trastuzumab before surgery plus adjuvant trastuzumab (11 cycles). Findings: 142 patients were randomized and treated (PET responders, n = 69; Group A, n = 48; Group B, n = 25). 5-year disease-free survival rates were 90.5% (95% CI: 80.0-95.6%) in PET responders, 90.2% (95% CI: 75.9-96.2%) in Group A, and 76.0% (95% CI: 54.2-88.4%) in Group B. However, no difference was observed between randomised arms in a sensitivity analysis. During adjuvant therapy, the incidence of Grade >= 3 (Group A: 25.6%; Group B 12.5%) and serious adverse events (Group A: 18.6%; Group B 12.5%) was higher in Group A vs Group B, but with no apparent effect on cardiac events. Interpretation: In patients with HER2-positive breast cancer, an intervention based on early PET assessment and improvement of pCR does not modify disease-free survival. (C) 2020 The Authors. Published by Elsevier Ltd.
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