Shankar Abhishek, Roy Shubham, Rath Goura Kishor, Julka Pramod Kumar, Kamal Vineet Kumar, Malik Abhidha, Patil Jaineet, Jeyaraj Pamela Alice, Mahajan Manmohan K
Department of Radiation Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, Delhi, India E-mail :
Asian Pac J Cancer Prev. 2015;16(15):6359-64. doi: 10.7314/apjcp.2015.16.15.6359.
Preclinical studies have shown that the combination of an aromatase inhibitor (AI) and capecitabine in estrogen receptor (ER)-positive cell lines enhance antitumor efficacy. This retrospective analysis of a group of patients with metastatic breast cancer (MBC) evaluated the efficacy and safety of combined AI with capecitabine.
Patients with hormone receptor-positive metastatic breast cancer treated between 1st January 2005 and 31st December 2010 with a combination of capecitabine and AI were evaluated and outcomes were compared with those of women treated with capecitabine in conventional dose or AI as a monotherapy.
Of 72 patients evaluated, 31 received the combination treatment, 22 AI and 19 capecitabine. The combination was used in 20 patients as first-line and 11 as second-line treatment. Mean age was 46.2 years with a range of 28-72 years. At the time of progression, 97% had a performance status of <2 and 55% had visceral disease. No significant difference was observed between the three groups according to clinical and pathological features. Mean follow up was 38 months with a range of 16-66 months. The median PFS of first-line treatment was significantly better for the combination (PFS 21 months vs 8.0 months for capecitabine and 15.0 months for AI). For second-line treatment, the PFS was longer in the combination compared with capecitabine and Al groups (18 months vs. 5.0 months vs. 11.0 months, respectively). Median 2 year and 5 year survival did not show any significant differences among combination and monotherapy groups. The most common adverse events for the combination group were grade 1 and 2 hand-for syndrome (69%), grade 1 fatigue (64%) and grade 1 diarrhoea (29%). Three grade 3 hand-foot syndrome events were reported.
Combination treatment with capecitabine and AI used as a first line or second line treatment was safe with much lowered toxicity. Prospective randomized clinical trials should evaluate the use of combination therapy in advanced breast cancer to confirm these findings.
临床前研究表明，芳香化酶抑制剂（AI）与卡培他滨联合应用于雌激素受体（ER）阳性细胞系可增强抗肿瘤疗效。本对一组转移性乳腺癌（MBC）患者的回顾性分析评估了AI联合卡培他滨的疗效和安全性。
对2005年1月1日至2010年12月31日期间接受卡培他滨与AI联合治疗的激素受体阳性转移性乳腺癌患者进行评估，并将结果与接受常规剂量卡培他滨治疗或AI单药治疗的女性患者进行比较。
在评估的72例患者中，31例接受联合治疗，22例接受AI治疗，19例接受卡培他滨治疗。联合治疗用于20例患者的一线治疗和11例患者的二线治疗。平均年龄为46.2岁，范围为28至72岁。疾病进展时，97%的患者体能状态<2，55%的患者有内脏疾病。根据临床和病理特征，三组之间未观察到显著差异。平均随访38个月，范围为16至66个月。一线治疗的联合组中位无进展生存期显著更好（联合组无进展生存期为21个月，卡培他滨组为8.0个月，AI组为15.0个月）。对于二线治疗，联合组的无进展生存期长于卡培他滨组和AI组（分别为18个月、5.0个月和11.0个月）。联合组和单药治疗组的2年和5年中位生存率未显示任何显著差异。联合组最常见的不良事件为1级和2级手足综合征（69%）、1级疲劳（64%）和1级腹泻（29%）。报告了3例3级手足综合征事件。
卡培他滨与AI联合作为一线或二线治疗安全且毒性大大降低。前瞻性随机临床试验应评估联合治疗在晚期乳腺癌中的应用以证实这些发现。
