Voutsadakis Ioannis A
Division of Medical Oncology, Department of Internal Medicine, Sault Area Hospital, Sault Ste Marie, Ontario, Canada; Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Eur J Breast Health. 2018 Jan 1;14(1):10-16. doi: 10.5152/ejbh.2017.3563. eCollection 2018 Jan.
Oral etoposide has been used as a later line therapy for metastatic breast cancer for more than twenty years. Its efficacy and clinical usefulness has been suggested in small phase II studies in the metastatic breast cancer population and the drug has also the added advantage of convenient oral administration. Despite these advantages, the place of oral etoposide in treatment of metastatic breast cancer has been challenged in the last decade due to introduction of several other chemotherapeutics, including options available orally, as well as novel targeted therapies. This report pools the data on response rates and survival from all available oral etoposide studies in order to reach a more precise estimate of the clinical benefit of the drug.
A review of the literature was performed for studies of oral etoposide in metastatic breast cancer. Data were extracted from eligible studies and summary statistics derived. Calculations of pooled response rates and survival estimates were performed according to a random or fixed effect model as appropriate.
The pooled estimate of Response Rate derived from twelve studies found in the English literature was 18.5% (95% CI 11.5-25.5%). The pooled estimate of Clinical Benefit Rate (CBR) was 45.8% (95% CI 38.6-53.0%) and median Overall Survival (OS) approached 1 year. Summarized adverse effects profile data show an overall manageable toxicity.
This pooled analysis provides evidence of a moderate clinical effectiveness of oral etoposide in metastatic breast cancer that could be useful in situations that options are limited but active treatment still appropriate.
口服依托泊苷作为转移性乳腺癌的二线治疗药物已使用二十多年。在转移性乳腺癌患者的小型II期研究中已表明其疗效及临床实用性，且该药物还具有口服给药方便的额外优势。尽管有这些优点，但在过去十年中，由于引入了其他几种化疗药物，包括口服可用的药物以及新型靶向疗法，口服依托泊苷在转移性乳腺癌治疗中的地位受到了挑战。本报告汇总了所有可用的口服依托泊苷研究中的缓解率和生存率数据，以便更精确地评估该药物的临床获益。
对口服依托泊苷治疗转移性乳腺癌的研究进行文献综述。从符合条件的研究中提取数据并得出汇总统计数据。根据适当情况，采用随机或固定效应模型计算汇总缓解率和生存估计值。
从英文文献中找到的12项研究得出的汇总缓解率估计值为18.5%（95%置信区间11.5 - 25.5%）。临床获益率（CBR）的汇总估计值为45.8%（95%置信区间38.6 - 53.0%），中位总生存期（OS）接近1年。汇总的不良反应概况数据显示总体毒性可控。
这项汇总分析提供了证据，表明口服依托泊苷在转移性乳腺癌中具有一定的临床有效性，在治疗选择有限但仍适合积极治疗的情况下可能有用。
