Kassam Farrah, Enright Katherine, Dent Rebecca, Dranitsaris George, Myers Jeff, Flynn Candi, Fralick Michael, Kumar Ritu, Clemons Mark
Division of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Clin Breast Cancer. 2009 Feb;9(1):29-33. doi: 10.3816/CBC.2009.n.005.
Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. This has implications for clinical practice and trial design. We evaluated the duration of first-, second-, and third-line chemotherapy as a surrogate for duration of treatment response.
We performed a retrospective multicenter chart review of patients with triple-negative MBC receiving palliative chemotherapy. Primary outcome was duration of palliative chemotherapy, and secondary outcome was to identify prognostic variables.
A total of 111 patients were analyzed. Median age at diagnosis was 51 years (range, 26-82 years). Fourteen percent of patients presented with MBC. Twenty-seven percent received neoadjuvant chemotherapy, and 48% received adjuvant chemotherapy. Median distant disease-free interval (DDFI) was 18 months (range, 0-172 months). At presentation of MBC, 68% had visceral and 71% had multiple sites of disease. Median survival with MBC was 13.3 months (range, 0.8-99.8 months). Median duration of first-line palliative therapy was 11.9 weeks (range, 0-73.1 weeks). Eighty-seven patients (78%) went on to receive second-line therapy with a median duration of 9 weeks (range, 0-120.9 weeks), and 55 (49%) received third-line therapy with a median duration of 4 weeks (range, 0-59 weeks). Multivariate analysis revealed that age < 50 years, ALP > 120 U/L, history of previous chemotherapy, DDFI < 12 months, and visceral presentation were all independently associated with a poor prognosis.
Despite the poorer overall prognosis of patients with triple-negative disease, there remains considerable heterogeneity in individual outcomes. Many women with recurrent triple-negative disease will progress quickly on first-, second-, and third-line palliative treatment. Future clinical trials in this population must take into account their shorter time to progression when determining optimal trial design.
临床经验表明，许多三阴性转移性乳腺癌（MBC）女性患者复发迅速。这对临床实践和试验设计具有重要意义。我们评估了一线、二线和三线化疗的持续时间，以此作为治疗反应持续时间的替代指标。
我们对接受姑息化疗的三阴性MBC患者进行了一项回顾性多中心病历审查。主要结局是姑息化疗的持续时间，次要结局是确定预后变量。
共分析了111例患者。诊断时的中位年龄为51岁（范围26 - 82岁）。14%的患者初诊时即为MBC。27%的患者接受了新辅助化疗，48%的患者接受了辅助化疗。中位远处无病生存期（DDFI）为18个月（范围0 - 172个月）。在MBC初诊时，68%的患者有内脏转移，71%的患者有多个病灶部位。MBC患者的中位生存期为13.3个月（范围0.8 - 99.8个月）。一线姑息治疗的中位持续时间为11.9周（范围0 - 73.1周）。87例患者（78%）继续接受二线治疗，中位持续时间为9周（范围0 - 120.9周），55例患者（49%）接受三线治疗，中位持续时间为4周（范围0 - 59周）。多因素分析显示，年龄<50岁、碱性磷酸酶（ALP）>120 U/L、既往化疗史、DDFI<12个月以及内脏转移均与预后不良独立相关。
尽管三阴性疾病患者的总体预后较差，但个体结局仍存在相当大差异。许多复发性三阴性疾病女性患者在一线、二线和三线姑息治疗中进展迅速。该人群未来的临床试验在确定最佳试验设计时必须考虑到其较短的疾病进展时间。
