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首页> 外文期刊>Cancer Communications >Hormonal therapy might be a better choice as maintenance treatment than capecitabine after response to first-line capecitabine-based combination chemotherapy for patients with hormone receptor-positive and HER2-negative, metastatic breast cancer
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Hormonal therapy might be a better choice as maintenance treatment than capecitabine after response to first-line capecitabine-based combination chemotherapy for patients with hormone receptor-positive and HER2-negative, metastatic breast cancer

机译：对于激素受体阳性和HER2阴性，转移性乳腺癌的患者，在一线基于卡培他滨的联合化疗后，激素治疗可能是比卡培他滨更好的维持治疗方法

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Both hormonal therapy (HT) and maintenance capecitabine monotherapy (MCT) have been shown to extend time to progression (TTP) in patients with metastatic breast cancer (MBC) after failure of taxanes and anthracycline-containing regimens. However, no clinical trials have directly compared the efficacy of MCT and HT after response to first-line capecitabine-based combination chemotherapy (FCCT) in patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. We retrospectively analyzed the charts of 138 HR-positive and HER2-negative MBC patients who were in non-progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, in Beijing, China. The median number of first-line chemotherapy cycles was 6 (range, 4–8); combined agents included taxanes, vinorelbine, or gemcitabine. Of these 138 patients, 79 received MCT, and 59 received HT. Single-agent capecitabine was administered at a dose of 1250 mg/m2 twice daily for 14 days, followed by a 7-day rest period, repeated every 3 weeks. Of the 59 patients who received HT, 37 received aromatase inhibitors (AIs), 8 received selective estrogen receptor modulators (SERMs), and 14 received goserelin plus either AIs or SERMs. We then compared the MCT group and HT group in terms of treatment efficacy. With a median follow-up of 43 months, patients in the HT group had a much longer TTP than patients in the MCT group (13 vs. 8 months, P = 0.011). When TTP was adjusted for age, menopausal status, Karnofsky performance status score, disease-free survival, site of metastasis, number of metastatic sites, and response status after FCCT, extended TTP was still observed for patients in the HT group (hazard ratio: 0.63; 95% confidence interval: 0.44–0.93; P = 0.020). We also observed a trend of overall survival advantage for patients in the HT group vs. patients in the MCT group, but the difference was not significant (43 vs. 37 months, P = 0.400). In addition, patients in the HT group generally tolerated the treatment well, whereas patients in the MCT group experienced grades 3–4 adverse events, the most frequent of which were hand-foot syndrome (15.8%) and hematologic abnormalities (7.6%). For HR-positive and HER2-negative MBC patients, HT might be considered a treatment after response to FCCT but prior to MCT as a long-term administration.
机译：在紫杉烷类药物和含蒽环类抗生素治疗失败的转移性乳腺癌（MBC）患者中，激素治疗（HT）和维持性卡培他滨单药治疗（MCT）均可延长病情发展时间（TTP）。但是，尚无任何临床试验直接比较基于一线卡培他滨的联合化疗（FCCT）对激素受体（HR）阳性和人表皮生长因子受体2（HER2）阴性的患者的MCT和HT的疗效乳腺癌。我们回顾性分析了138例HR阳性和HER2阴性的MBC患者的病历，这些患者在FCCT后处于非进展状态，并于2003年至2012年在中国医学科学院肿瘤研究所和医院接受治疗，位于中国北京。一线化疗周期的中位数为6个（范围为4-8）。合并的药物包括紫杉烷类，长春瑞滨或吉西他滨。在这138例患者中，有79例接受了MCT，有59例接受了HT。单剂卡培他滨的剂量为1250 mg / m2，每天两次，共14天，然后休息7天，每3周重复一次。在接受HT治疗的59例患者中，有37例接受了芳香化酶抑制剂（AIs），有8例接受了选择性雌激素受体调节剂（SERM），有14例接受了戈舍瑞林加AIs或SERMs治疗。然后，我们根据治疗效果比较了MCT组和HT组。中位随访43个月，HT组患者的TTP比MCT组患者更长（13 vs. 8个月，P = 0.011）。当根据年龄，更年期状态，卡诺夫斯基表现状态评分，无病生存期，转移部位，转移部位数量和FCCT后的反应状态调整TTP时，HT组患者仍观察到延长的TTP（危险比： 0.63; 95％置信区间：0.44–0.93; P = 0.020）。我们还观察到HT组患者与MCT组患者的总体生存优势呈趋势，但差异并不显着（43 vs. 37个月，P = 0.400）。另外，HT组的患者对治疗的耐受性一般，而MCT组的患者则发生3至4级不良反应，其中最常见的是手足综合征（15.8％）和血液学异常（7.6％）。对于HR阳性和HER2阴性的MBC患者，可以将HT视为对FCCT应答后但长期作为MCT之前的治疗方法。

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