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新辅助化疗后手术是局部晚期乳腺癌的治疗标准。早期确定新辅助化疗敏感的有效者，对于乳腺癌（尤其对于主要依靠化疗的三阴性乳腺癌）而言至关重要。 2018年8月20日，美国转化肿瘤学会官方期刊《肿瘤学家》在线发表复旦大学附属肿瘤医院肿瘤研究所上海医学院生物医学研究院王若曦、陈盛、黄亮、邵志敏等学者的研究报告，探讨了三阴性乳腺癌新辅助化疗期间血清生物标志变化对治疗效果和患者生存的早期预测作用。 该研究于2009年1月～2015年7月从复旦大学附属肿瘤医院入组303例接受术前每周紫杉醇＋卡铂新辅助化疗的三阴性乳腺癌患者，新辅助化疗开始之前、第三周期之前、手术之前采集血清标本，检测29种血清生物标志与新辅助化疗效果的相关性，随后分析每种所选生物标志对治疗效果预测和生存结局预后的作用。 结果发现，血管内皮生长因子是唯一与治疗效果相关的生物标志，病理完全缓解与否相比，血管内皮生长因子水平显著降低（P<0.001）。 单因素和多因素分析表明，新辅助化疗第三周期之前的血管内皮生长因子相对变化，对于病理完全缓解与否，均有高灵敏度和特异度的显著预测作用。血管内皮生长因子水平还与无病生存独立相关。 因此，该研究结果表明，监测血清血管内皮生长因子有助于新辅助化疗早期阶段确定不同治疗效果和不同疾病复发风险的患者。血清血管内皮生长因子还可作为传统影像学评估治疗效果的替代方法，对可手术和局部晚期三阴性乳腺癌的新辅助化疗策略进行个体化和调整。 Oncologist. 2018 Aug 20. [Epub ahead of print] Monitoring Serum VEGF in Neoadjuvant Chemotherapy for Patients with Triple-Negative Breast Cancer: A New Strategy for Early Prediction of Treatment Response and Patient Survival. Ruo-Xi Wang, Sheng Chen, Liang Huang, Ying Zhou, Zhi-Ming Shao. Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Institutes of Biomedical Science, Fudan University, Shanghai, China. BACKGROUND: This study aimed to investigate the clinical utility of serum biomarker changes during neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC). METHODS: A total of 303 patients with TNBC were included in this study. Serum samples were taken at three time points during NAC: baseline, prior to the third cycle, and prior to surgery. Luminex multibiomarker panel for 29 serum biomarkers was used to detect their correlation with NAC response. The predictive and prognostic value of each selected biomarker was then studied. RESULTS: Vascular endothelial growth factor (VEGF) was the only biomarker that correlated with treatment response, with a decreasing trend in pCR patients relative to non-pCR patients (p < .001). Univariable and multivariable analyses revealed that the relative change in VEGF prior to the third cycle of NAC had a remarkable predictive value for both pCR and pathological nonresponse with high sensitivity and specificity. VEGF was also independently correlated with disease-free survival. CONCLUSION: Our findings indicate that monitoring serum VEGF could help identify patients with different responses at an early time point of NAC and at varying risk of disease relapse. Serum VEGF may also serve as an alternative to traditional response-evaluating methodologies in tailoring and modifying the NAC strategy for both operable and advanced TNBCs. IMPLICATIONS FOR PRACTICE: Neoadjuvant chemotherapy (NAC) followed by definitive surgery is a standard of care for locally advanced breast cancer. The identification of sensitive responders to neoadjuvant therapy is highly significant for breast cancer, especially triple-negative breast cancer (TNBC). Results of this study indicate that the monitoring of serum vascular endothelial growth factor (VEGF) could identify patients with favorable or poor responses at an early time point of NAC. Furthermore, the prediction power of VEGF was better than traditional response-evaluating methods. VEGF might serve as a complement or alternative to traditional imaging-based response-evaluating methodologies in tailoring systemic treatment strategies for both operable and advanced TNBCs. DOI: 10.1634/theoncologist.2017-0602
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