OncoCentre Dresden/Freiberg, Leipziger Str. 118, 01127, Dresden, Germany.
Centre for Haematology and Oncology, Harsefelder Str. 6-8, 21680, Stade, Germany.
Breast Cancer. 2018 May;25(3):275-283. doi: 10.1007/s12282-017-0823-7. Epub 2017 Dec 4.
Several regimens for which efficacy was established in randomized controlled trials are recommended in current treatment guidelines for early breast cancer. However, knowledge on use and effectiveness of commonly administered chemotherapeutic agents in real-life care and across all breast cancer subtypes is limited.
The prospective, multicentre German TMK cohort study (Tumour Registry Breast Cancer) recruited patients in 148 oncology outpatient-centres. Data from 1650 patients who completed adjuvant chemotherapy were analysed regarding treatment regimens and taxane use from 2007 to 2014. The association of patient characteristics with application of taxane-free regimens was examined with a multivariate regression model.
The preferred adjuvant treatment shifted from fluorouracil, anthracycline and cyclophosphamide containing regimens to anthracycline/taxane combinations. Taxane use increased for all subtypes, and the greatest rise was among node-negative patients. Older age, node-negativity, lower grading, HR-positive/HER2-negative subtype and earlier start year of therapy were significantly associated with taxane-free therapy.
Treatment with anthracycline/taxane-based chemotherapy in Germany has been rising for every subtype. The increased taxane use reflects updated guideline recommendations over the past decade. Cohort studies like the TMK provide insight into real-life treatment of patients outside of clinical trials.
目前的早期乳腺癌治疗指南推荐了几种在随机对照试验中已证实有效的治疗方案。然而，关于在实际护理中以及在所有乳腺癌亚型中常用化疗药物的使用情况和疗效知之甚少。
前瞻性、多中心德国 TMK 队列研究（肿瘤登记处乳腺癌）在 148 个肿瘤门诊中心招募患者。分析了 2007 年至 2014 年间接受辅助化疗的 1650 例患者的治疗方案和紫杉烷使用情况。采用多变量回归模型研究患者特征与无紫杉烷方案应用的相关性。
辅助治疗的首选方案从含有氟尿嘧啶、蒽环类和环磷酰胺的方案转变为蒽环类/紫杉烷联合方案。紫杉烷的使用在所有亚型中都有所增加，而在淋巴结阴性患者中增加最多。年龄较大、淋巴结阴性、分级较低、HR 阳性/HER2 阴性亚型以及治疗开始年份较早与无紫杉烷治疗显著相关。
德国蒽环类/紫杉烷为基础的化疗治疗在每个亚型中都在增加。紫杉烷使用的增加反映了过去十年中指南推荐的更新。像 TMK 这样的队列研究为了解临床试验之外的患者实际治疗情况提供了深入了解。
