Kontani Keiichi, Hashimoto Shin-Ichiro, Murazawa Chisa, Norimura Shoko, Tanaka Hiroaki, Ohtani Masahiro, Fujiwara-Honjo Naomi, Date Manabu, Teramoto Koji, Houchi Hitoshi, Yokomise Hiroyasu
Department of Thoracic, Breast and Endocrine Surgery, Kagawa University Faculty of Medicine, Miki, Kagawa 761-0793, Japan.
Department of Surgery, Japanese Red Cross Hospital, Takamatsu, Kagawa 760-0017, Japan.
Mol Clin Oncol. 2016 Jun;4(6):947-953. doi: 10.3892/mco.2016.841. Epub 2016 Mar 30.
The survival of patients with metastatic breast cancer (MBC) has not improved, despite recent advances in therapeutic strategies. This is mainly due to the fact that cytotoxic agents cannot be administered over a long period, even if they exhibit favorable activity, due to treatment-related side effects or acquisition of tumor resistance to the administered agents. Thus, the development of therapeutic strategies that may be used over a long time period is required to improve survival. We assessed the availability and clinical outcomes of metronomic chemotherapy, which is defined as continuous or frequent treatment with low doses of cytotoxic drugs. A total of 80 patients with MBC received chemotherapy in the metastatic setting, and the clinicopathological factors and clinical outcomes were retrospectively compared between 52 patients who received metronomic regimens and 28 patients who received other cytotoxic regimens. As regards clinical outcomes, the median time-to-treatment failure (TTF) and overall survival (OS) were significantly longer in the metronomic group compared with those in the non-metronomic group (TTF, 15 vs. 4 months, P=0.0001; and OS, 53 vs. 28 months P=0.0012, respectively). In the metronomic group, none of the 18 patients who responded to the regimen had triple-negative (TN) cancer (17 had luminal-type tumors and 1 had a human epidermal factor receptor 2-type tumor). Furthermore, TTF and OS were significantly longer in patients with non-TN cancer compared with those in patients with TN cancer in the metronomic group (TTF, 16 vs. 7 months, P=0.0014; and OS, 108 vs. 20 months, P=0.000007, respectively). The proportion of patients who experienced treatment-related adverse events was significantly lower in the metronomic group compared with that in the non-metronomic group (36.5 vs. 61.5%, respectively; P=0.038). In conclusion, metronomic chemotherapy is a viable option for luminal-type MBC in terms of effectiveness and minimal toxicity, regardless of metastatic sites or prior treatment. However, an alternative treatment is required for TN cancer.
尽管治疗策略最近有所进展，但转移性乳腺癌（MBC）患者的生存率并未提高。这主要是由于细胞毒性药物即使显示出良好的活性，也不能长期给药，因为存在与治疗相关的副作用或肿瘤对所给药产生耐药性。因此，需要开发可长期使用的治疗策略以提高生存率。我们评估了节拍化疗的可行性和临床结果，节拍化疗定义为用低剂量细胞毒性药物进行持续或频繁治疗。共有80例MBC患者在转移期接受化疗，对接受节拍方案的52例患者和接受其他细胞毒性方案的28例患者的临床病理因素和临床结果进行了回顾性比较。关于临床结果，节拍组的中位治疗失败时间（TTF）和总生存期（OS）显著长于非节拍组（TTF分别为15个月对4个月，P = 0.0001；OS分别为53个月对28个月，P = 0.0012）。在节拍组中，对该方案有反应的18例患者中无一例为三阴性（TN）癌（17例为管腔型肿瘤，1例为人表皮生长因子受体2型肿瘤）。此外，节拍组中非TN癌患者的TTF和OS显著长于TN癌患者（TTF分别为16个月对7个月，P = 0.0014；OS分别为108个月对20个月，P = 0.000007）。节拍组发生治疗相关不良事件的患者比例显著低于非节拍组（分别为36.5%对61.5%；P = 0.038）。总之，无论转移部位或既往治疗如何，节拍化疗在有效性和最小毒性方面是管腔型MBC的可行选择。然而，TN癌需要替代治疗。
