ノード陽性乳がんの全身療法後の応答誘導性治療のためのヨウ素シードマーキングプロトコル
Annemiek K E van Hemert1, Ariane A van Loevezijn1, Marie-Sophie P D Baas1
1Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
JAMA oncology
|August 28, 2025
まとめ
原始的全身治療 (PST) の後に完全な応答を達成したノード陽性乳がん患者のMARIプロトコルによる応答誘導治療は安全です. このアプローチは,頭再発を大幅に減らし,適格な患者に過剰な治療を回避します.
科学分野:
- 腫瘍学
- 手術腫瘍学
- 乳がん 研究
背景:
- 大抵のノード陽性乳がん患者は,主治体治療 (PST) の後に帯リンパ節解剖 (ALND) または放射線治療 (RT) を受けます.
- 病理的な完全応答 (pCR) を達成した患者の下腕治療の必要性は不確実であり,過剰治療につながる可能性があります.
研究 の 目的:
- 応答指針による頭治療戦略の腫瘍学的結果を評価する.
- 臨床的にノード陽性 (cN+) の乳がんの患者で,PST後にpCRを達成した患者で,MARI (ヨウ素シードマーク) リンパ節プロトコルの有効性を評価する.
主な方法:
- 単一センターのコホート研究では,MARIプロトコルで治療された限られた帯リンパ節を有するcN+乳がん患者が含まれていました (2014年7月~2021年12月).
- 患者はPST後のMARIマークリンパ節切除を受けた. pCR (ypN0) を有する人はさらに頭治療を避け,残留病 (ypN+) を有する人はRTを受けた.
- 頭再発,侵襲性疾患のない5年生存期 (iDFS),全生存期 (OS) を含む腫瘍学的アウトカムが分析されました.
主要な成果:
- 350人の患者のうち,135人 (39%) がypN0を有し,さらなる頭治療を受けなかった.
- ypN0患者では0. 7%, ypN+患者では2. 3%でした.
- 5年間のiDFSはypN0の93%とypN+の87%で,5年間のOSはypN0の98%とypN+の93%でした.
結論:
- MARIプロトコルによる応答誘導治療は,PST後の選択されたcN+乳がん患者で,非常に低い回再発リスクと関連しています.
- この戦略は,優れた腫瘍学的アウトカムを維持しながら,帯の過剰治療を回避できる患者を効果的に特定します.
- MARIプロトコルは,治療反応に基づく帯治療の緩和のための実行可能なアプローチを提供します.
関連する概念動画
Cancer Therapies
8.5K
Cancer therapies are various modes of treatment, such as surgery, radiation therapy, and chemotherapy that are administered to cancer patients.
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
8.5K
Targeted Cancer Therapies
7.0K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
7.0K
Treatment Resistant Cancers
2.6K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
2.6K
Tumor Immunotherapy
2.5K
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
2.5K


