German Breast Group, Neu-Isenburg, Germany.
BMC Cancer. 2011 Apr 12;11:131. doi: 10.1186/1471-2407-11-131.
Chemotherapy dose delay and/or reduction lower relative total dose intensity (RTDI) and may affect short- and long-term outcome of metastatic breast cancer (MBC) patients.
Based on 933 individual patients' data of from 3 randomized MBC trials using an anthracycline and taxane we examined the impact of RTDI on efficacy and determined the lowest optimal RTDI for MBC patients.
Median time to disease progression (TTDP) and overall survival (OS) of all patients were 39 and 98 weeks. Overall higher RTDI was correlated with a shorter TTDP (log-rank p = 0.0525 for 85% RTDI cut-off). Proportional hazards assumption was violated, there was an early drop in the TTDP-curve for the high RTDI group. It was explained by the fact that patients with primary disease progression (PDP) do have a high RTDI per definition. Excluding those 114 patients with PDP the negative correlation between RTDI and TTDP vanished. However, non-PDP patients with RTDI-cut-off levels <85% showed a shorter OS than patients with higher RTDI levels (p = 0.0086).
Optimizing RTDI above 85% appears to improve long-term outcome of MBC patients receiving first-line chemotherapy. Lowering RTDI had no negative influence on short term outcome like OR and TTDP.
化疗剂量的延迟和/或减少会降低相对总剂量强度（RTDI），并可能影响转移性乳腺癌（MBC）患者的短期和长期预后。
基于 3 项使用蒽环类药物和紫杉烷的随机 MBC 试验中 933 名个体患者的数据，我们检查了 RTDI 对疗效的影响，并确定了 MBC 患者的最低最佳 RTDI。
所有患者的中位疾病进展时间（TTDP）和总生存期（OS）分别为 39 和 98 周。总体而言，较高的 RTDI 与较短的 TTDP 相关（85%RTDI 截止值的对数秩检验 p=0.0525）。比例风险假设受到违反，高 RTDI 组的 TTDP 曲线早期下降。这是因为根据定义，有原发性疾病进展（PDP）的患者的 RTDI 较高。排除 114 例 PDP 患者后，RTDI 与 TTDP 之间的负相关关系消失。然而，RTDI 截止值<85%的非 PDP 患者的 OS 短于 RTDI 水平较高的患者（p=0.0086）。
优化 RTDI 至 85%以上似乎可以改善接受一线化疗的 MBC 患者的长期预后。降低 RTDI 对 OR 和 TTDP 等短期预后没有负面影响。
