Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Clin Transl Oncol. 2018 Oct;20(10):1280-1288. doi: 10.1007/s12094-018-1859-7. Epub 2018 Mar 28.
Capecitabine has been studied as a radiosensitizer, and our study seeks to examine the association of concurrent capecitabine/radiation therapy (RT) on event-free- (EFS) and overall survival (OS) in women with breast cancer (BC) with residual disease after neoadjuvant chemotherapy (NAC).
METHODS/PATIENTS: In a retrospective study of women with BC who received adriamycin/taxane-based NAC from 2004-2016, we identified 21 women administered concurrent capecitabine/RT. To assess differences in survival, we selected a clinical control cohort (n = 57) based on criteria used to select patients for capecitabine/RT. We also created a matched cohort (2:1), matching on tumor subtype, pathological stage and age (< 50 or 50+ years). Differences in EFS, using STEEP criteria, and OS, using all-cause mortality, between those who received capecitabine/RT and controls were assessed.
Of the 21 women who received capecitabine/RT, median age was 52 years. The majority were pathologic stage III (n = 15) and hormone receptor-positive/HER2-negative BC (n = 20). In those receiving capecitabine/RT, there were 9 events, compared with 14 events in clinical and 10 events in matched controls. Capecitabine/RT was associated with worse OS in clinical (HR 3.83 95% CI 1.12-13.11, p = 0.03) and matched controls (HR 3.71 95% CI 1.04-13.18, p = 0.04), after adjusting for clinical size, pathological stage and lymphovascular invasion. Capecitabine/RT was also associated with a trend towards worse EFS in clinical (HR 2.41 95% CI 0.86-6.74, p = 0.09) and matched controls (HR 2.68 95% CI 0.91-7.90, p = 0.07) after adjustment.
Concurrent capecitabine/RT after NAC is associated with worse survival and should be carefully considered in BC.
卡培他滨已被研究作为放射增敏剂，我们的研究旨在探讨在接受新辅助化疗（NAC）后有残留疾病的乳腺癌（BC）女性中，卡培他滨/放疗（RT）同期治疗与无事件生存（EFS）和总生存（OS）的相关性。
方法/患者：在一项对 2004 年至 2016 年间接受蒽环类药物/紫杉类药物为基础的 NAC 的 BC 女性的回顾性研究中，我们确定了 21 名接受卡培他滨/RT 同期治疗的女性。为了评估生存差异，我们根据用于选择卡培他滨/RT 患者的标准选择了一个临床对照队列（n=57）。我们还创建了一个匹配队列（2：1），按肿瘤亚型、病理分期和年龄（<50 岁或 50 岁以上）进行匹配。使用 STEEP 标准评估接受卡培他滨/RT 的患者和对照组之间 EFS 的差异，并使用全因死亡率评估 OS 的差异。
在接受卡培他滨/RT 的 21 名女性中，中位年龄为 52 岁。大多数为病理分期 III 期（n=15）和激素受体阳性/HER2 阴性 BC（n=20）。在接受卡培他滨/RT 的患者中，有 9 例事件，而临床对照组有 14 例，匹配对照组有 10 例。在临床和匹配的对照组中，卡培他滨/RT 与 OS 更差相关（HR 3.83 95% CI 1.12-13.11，p=0.03），在调整临床大小、病理分期和脉管侵犯后，卡培他滨/RT 与 OS 更差相关（HR 3.71 95% CI 1.04-13.18，p=0.04）。在调整后，卡培他滨/RT 与临床（HR 2.41 95% CI 0.86-6.74，p=0.09）和匹配对照组（HR 2.68 95% CI 0.91-7.90，p=0.07）的 EFS 更差也有一定趋势。
NAC 后卡培他滨/RT 同期治疗与生存更差相关，在 BC 中应慎重考虑。
