ESME计划中HER2阳性转移性乳腺癌患者辅助抗HER2治疗对特征和结果的真实世界影响
Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program.
发表日期：2023 Aug 17
作者：
Fanny Le Du, Matthieu Carton, Thomas Bachelot, Mahasti Saghatchian, Barbara Pistilli, Etienne Brain, Delphine Loirat, Laurence Vanlemmens, Thomas Vermeulin, George Emile, Anthony Gonçalves, Mony Ung, Marie Robert, Anne Jaffre, Isabelle Desmoulins, Christelle Jouannaud, Lionel Uwer, Jean Marc Ferrero, Marie-Ange Mouret-Reynier, William Jacot, Michaël Chevrot, Suzette Delaloge, Véronique Diéras
来源：
Disease Models & Mechanisms
摘要：
虽然辅助癌症治疗可以提高治愈率，但也可能诱导克隆选择和肿瘤抗药性。目前尚不清楚（新）辅助抗HER2治疗是否会影响HER2阳性（HER2+）转移性乳腺癌（MBC）的复发模式和预后。我们旨在在大型多中心ESME现实世界数据库中评估这一点。我们在法国ESME计划中评估了具有复发疾病的HER2+ MBC患者的特征和预后（总生存期（OS）和一线治疗下无进展生存期（PFS1）），并根据之前是否接受辅助曲妥珠单抗进行分析。多元分析使用校正了基线人口统计学、预后因素、接受的辅助治疗和无病生存期的Cox模型。2008年至2017年之间，进入ESME队列的2143名患有复发HER2+ MBC的患者。其中，56％接受了（新）辅助曲妥珠单抗治疗，2.5％在这种情况下接受其他抗HER2治疗。预先接受曲妥珠单抗的患者年龄较小，无病生存期较短，患有更多HR阴性疾病和转移部位更多。虽然曝光于辅助曲妥珠单抗的患者中，粗糙的中位生存期较差，与未接受曲妥珠单抗的患者相比（37.2个月（95％CI 34.4-40.3）与53.5个月（95％CI：47.6-60.1）），但此差异在多元模型中消失（HR = 1.05，95％CI 0.91-1.22）。PFS1的情况与之相同。在复发的HER2+ MBC患者中，接受辅助曲妥珠单抗治疗在调整了其他预后因素后并不能独立预测预后较差。© The Author(s) 2023. Published by Oxford University Press.
Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database.We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval.Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1.Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors.© The Author(s) 2023. Published by Oxford University Press.