Сравнение эффективности применения трастузумаба в течение 6 и 12 мес в адъювантном режиме при лечении пациенток с ранним HER2+ раком молочной железы в рандомизированных исследованиях III фазы

Представленырезультаты многоцентровых клинических исследований, на основании которых применение трастузумаба в течение 12 мес в адъювантном режиме было регламентировано в США и Европе как стандарт при лечении пациенток с ранним HER2+ раком молочной железы (РМЖ). Приведены данные многоцентрового рандомизированного клинического исследования фазы III (PHARE, NCT00381901), целью которого было сравнение эффективности применения трастузумаба в течение 6 или 12 мес по принципу «noninferiority». Результаты этого исследования, полученные при медиане периода наблюдения 42 мес, не подтвердили предположения, что применение трастузумаба для адъювантной терапии в течение 6 мес у пациенток с ранним HER2+ РМЖ не менее эффективно, чем в течение 12 мес, хотя при сокращении длительности лечения несколько снижается уровень кардиотоксичности.The results of multicenter clinical trial on the basis of 12-month adjuvant use of trastuzumab administered in the US and Europe as a standard in the treatment of patients with early HER2+ breast cancer are presented. The data of a multicenter rando mized clinical trial, phase III (PHARE, NCT00381901), the purpose of which was to compare the efficacy of trastuzumab for 6 months or 12 months on the principle of «non-inferiority» are considered. The results of this study obtained under a median follow-up 42 months, did not confirm the assumption that the adjuvant use of trastuzumab for 6 months in patients with early HER2+ breast cancer is not less effective than at 12 months, although the reduction in the duration of treatment is somewhat reduced level of cardiotoxicity

Unsupervised Polygonal Reconstruction of Noisy Contours by a Discrete Irregular Approach

International audienceIn this paper, we present an original algorithm to build a polygonal reconstruction of noisy digital contours. For this purpose, we first improve an algorithm devoted to the vectorization of discrete irregular isothetic objects. Afterwards we propose to use it to define a reconstruction process of noisy digital contours. More precisely, we use a local noise detector, introduced by Kerautret and Lachaud in IWCIA 2009, that builds a multi-scale representation of the digital contour, which is composed of pixels of various size depending of the local amount of noise. Finally, we compare our approach with previous works, by con- sidering the Hausdorff distance and the error on tangent orientations of the computed line segments to the original perfect contour. Thanks to both synthetic and real noisy objects, we show that our approach has interesting performance, and could be applied in document analysis systems

Predictors of early relapse in postmenopausal women with hormone receptor-positive breast cancer in the BIG 1-98 trial

Background: Aromatase inhibitors are considered standard adjuvant endocrine treatment of postmenopausal women with hormone receptor-positive breast cancer, but it remains uncertain whether aromatase inhibitors should be given upfront or sequentially with tamoxifen. Awaiting results from ongoing randomized trials, we examined prognostic factors of an early relapse among patients in the BIG 1-98 trial to aid in treatment choices. Patients and methods: Analyses included all 7707 eligible patients treated on BIG 1-98. The median follow-up was 2 years, and the primary end point was breast cancer relapse. Cox proportional hazards regression was used to identify prognostic factors. Results: Two hundred and eighty-five patients (3.7%) had an early relapse (3.1% on letrozole, 4.4% on tamoxifen). Predictive factors for early relapse were node positivity (P < 0.001), absence of both receptors being positive (P < 0.001), high tumor grade (P < 0.001), HER-2 overexpression/amplification (P < 0.001), large tumor size (P = 0.001), treatment with tamoxifen (P = 0.002), and vascular invasion (P = 0.02). There were no significant interactions between treatment and the covariates, though letrozole appeared to provide a greater than average reduction in the risk of early relapse in patients with many involved lymph nodes, large tumors, and vascular invasion present. Conclusion: Upfront letrozole resulted in significantly fewer early relapses than tamoxifen, even after adjusting for significant prognostic factor