真实世界中转移性乳腺癌的治疗：一线治疗的无进展生存期能否预测二线及后续治疗的获益？
Treatment of Metastatic Breast Cancer in a Real-World Scenario: Is Progression-Free Survival With First Line Predictive of Benefit From Second and Later Lines?
作者信息
Bonotto Marta, Gerratana Lorenzo, Iacono Donatella, Minisini Alessandro Marco, Rihawi Karim, Fasola Gianpiero, Puglisi Fabio
机构信息
Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy
出版信息
Oncologist. 2015 Jul;20(7):719-24. doi: 10.1634/theoncologist.2015-0002. Epub 2015 May 27.
INTRODUCTION
Despite the availability of several therapeutic options for metastatic breast cancer (MBC), no robust predictive factors are available to help clinical decision making. Nevertheless, a decreasing benefit from first line to subsequent lines of treatment is commonly observed. The aim of this study was to assess the impact of benefit from first-line therapy on outcome with subsequent lines.
METHODS
We analyzed a consecutive series of 472 MBC patients treated with chemotherapy (CT) and/or endocrine therapy (ET) between 2004 and 2012. We evaluated progression-free survival (PFS) at first (PFS1), second, third, and fourth therapeutic lines, according to treatment (ET and/or CT) and tumor subtypes.
RESULTS
In the whole cohort, median overall survival was 34 months, and median PFS1 was 9 months. A 6-month benefit was shown by 289 patients (63.5%) at first line, 128 (40.5%) at second line, 76 (33.8%) at third line, and 34 (23.3%) at fourth line. Not having a 6-month benefit at PFS1 was associated with less chance of benefit at second line (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.77, p = .0026) and at any line beyond first (OR: 0.39; 95% CI: 0.24-0.62, p < .0001). In the total series, after stratification for tumor subtypes, a strong predictive effect was observed among HER2-positive tumors (OR: 0.2; 95% CI: 0.05-0.73, p = .0152).
CONCLUSION
Our results suggest that the absence of at least a 6-month benefit in terms of PFS with first-line therapy predicts a reduced probability of benefit from subsequent therapeutic lines, especially in HER2-positive disease.
IMPLICATIONS FOR PRACTICE
This study supports evidence showing that the absence of a 6-month benefit in terms of progression-free survival with first-line therapy predicts a lack of benefit from subsequent therapeutic lines in metastatic breast cancer. The random distribution of benefit experienced by a subset of the cohort further spurs an interest in identifying predictive factors capable of identifying the most appropriate therapeutic strategy.
引言
尽管转移性乳腺癌（MBC）有多种治疗选择，但尚无有力的预测因素可帮助临床决策。然而，从一线治疗到后续治疗线的获益通常会逐渐减少。本研究的目的是评估一线治疗的获益对后续治疗线结局的影响。
方法
我们分析了2004年至2012年间连续接受化疗（CT）和/或内分泌治疗（ET）的472例MBC患者。我们根据治疗（ET和/或CT）和肿瘤亚型评估了一线（PFS1）、二线、三线和四线治疗的无进展生存期（PFS）。
结果
在整个队列中，中位总生存期为34个月，中位PFS1为9个月。289例患者（63.5%）在一线治疗时有6个月的获益，128例（40.5%）在二线治疗时有获益，76例（33.8%）在三线治疗时有获益，34例（23.3%）在四线治疗时有获益。PFS1时未获得6个月的获益与二线治疗时获益的可能性较低相关（比值比[OR]：0.48；95%置信区间[CI]：0.29-0.77，p = 0.0026），并且与一线之后的任何治疗线的获益相关（OR：0.39；95%CI：0.24-0.62，p < 0.0001）。在整个系列中，按肿瘤亚型分层后，在HER2阳性肿瘤中观察到强烈的预测作用（OR：0.2；95%CI：0.05-0.73，p = 0.0152）。
结论
我们的结果表明，一线治疗在PFS方面未获得至少6个月的获益预示着从后续治疗线获益的可能性降低，尤其是在HER2阳性疾病中。
对实践的启示
本研究支持了以下证据，即一线治疗在无进展生存期方面未获得6个月的获益预示着转移性乳腺癌患者从后续治疗线中无法获益。队列中一部分患者随机获得获益这一情况进一步激发了人们对识别能够确定最合适治疗策略的预测因素的兴趣。
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