谁取得新辅助治疗后病理完全缓解图像引导下穿刺活检的患者识别

Select groups of invasive breast cancer patients may be able to avoid surgery in future

MD安德森新闻Release December 09, 2016

In a pilot study conducted at得克萨斯大学MD安德森癌症中心的大学, image-guided biopsies identified select breast cancer patients who achieved pathologic complete response (pCR) after chemotherapy and/or targeted therapy, neoadjuvant systemic therapy (NST). Should the findings be replicated in future studies, this research would be the first indication that as the field moves toward more selective, personalized treatment, surgery may altogether be eliminated for a large group of patients.

Henry M. Kuerer, M.D., Ph.D，教授，乳腺肿瘤外科，MD安德森和研究的主要研究者给出的的最新摘要海报会议在2016San Antonio Breast Cancer Symposium。

Worldwide, triple negative and HER2 positive breast cancers account for about 370,000 women diagnosed annually, says Kuerer. With recent advances in neoadjuvant systemic therapy for both subsets of cancer, the pCR rates found at the time of surgery in these patients can be as high as 60 percent. This high rate of pCR naturally raises the question of whether surgery is required for all patients, particularly those who will receive adjuvant radiation.

“我们认为手术可能是多余的at least for these two subtypes of breast cancer – because of such a high chance for no evidence of disease at the time of pathological review,” says Kuerer. “If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed?”

面临的挑战是该标准乳房成像方法不能准确地NST后预测残留疾病。

“However, by doing the same image-guided, percutaneous needle biopsies after NST that we do at time of diagnosis, our preliminary research reveals we may be able to accurately predict which women will have cancer or not,” says Kuerer.

The prospective single-center study enrolled 34 women with early-stage (stage I, II, III) triple negative (23 patients) or HER-2 positive (11 patients) breast cancer. As per standard practice, all patients received NST. Prior to standard-of-care surgery, all participants consented to undergo image-guided fine needle aspiration (FNA) biopsy and an ultrasound and/or mammography guided vacuum-assisted core biopsy (VACB). The study measured for accuracy, false negative rate, and negative predictive value were calculated for FNA alone, VACB alone and FNA and VACB in combination. Breast pCR was defined as no residual disease at the time of surgery.

Median initial tumor size was 3 centimeters and 47.1 percent of patients had nodal metastasis at the time of diagnosis. After NST, the median residual tumor size was 0.9 cm, with 94.1 percent of patients having no palpable abnormality.

188bet体育网址研究人员发现，以下NST，VACB与FNA组合具有100％的准确率，0％的FNR，和用于测定残留病的100％的预测值。1个活检相关的不良事件，包括出血，血肿和挫伤，发生6例（17.6％）。

“With this knowledge, there’s an obligation to test whether no surgery, or ‘ultimate breast conserving therapy,’ is safe,” says Kuerer.

The accuracy of the preliminary findings led MD Anderson’s Institutional Review Board to approve a Phase II clinical trial, which soon is to open at MD Anderson and then across the MD Anderson Cancer Network. The study will enroll women with Stage I and II HER2-positive and triple negative breast cancer. Participants who achieve image-guided, biopsy-proved pCR after NST will undergo whole-breast radiation, without surgery. The trial will be the first using image-guided biopsies in this setting and not include surgery.

“这是一个迫切需要测试是否需要手术治疗。在我的病人中，约有过度治疗许多快递关注的交谈。他们希望的任何最小的治疗尽可能最人性化关怀，” Kuerer说。“如果这些研究结果证明是真的，这将是突破性的患者 - 在生理和心理上。”

In addition to Kuerer, other authors on the all-MD Anderson study include: Wei T. Yang, M.D., chair, Gaiane M. Rauch, M.D., Ph.D., Beatriz E. Adrada, M.D., Lumarie Santiago, M.D., Rosalind Candelaria, M.D., Elsa Arribas, M.D. and Tanya Moseley, M.D., all of Diagnostic Radiology; Savitri Krishnamurthy, M.D., Michael Gilcrease, M.D., Ph.D., both of Pathology; Kelly K. Hunt, M.D., chair, Abigail S. Caudle, M.D., Sarah M. DeSnyder, M.D., Anthony Lucci, Jr., M.D., Rosa Hwang, M.D., Mediget Teshome, M.D., and Makesha V. Miggins, M.D., all of Breast Cancer Surgery; Brian P. Hobbs, Ph.D., Biostatistics; Mariana Chavez Mac Gregor, M.D., Breast Medical Oncology and Health Services Research; Benjamin D. Smith, M.D., Ph.D., Radiation and Vincente Valero, M.D., Breast Medical Oncology.

The study was financially supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research, a Cancer Center Support Grant from the National Institutes of Health (NIH), CA16672, a NIH P30 grant, CA016672, and funding from the MD Anderson Clinical Research Funding Award Program.