Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France.
Gustave Roussy, 94805, Villejuif, France.
Breast Cancer Res Treat. 2019 Jan;173(2):397-406. doi: 10.1007/s10549-018-5017-2. Epub 2018 Oct 24.
HER2-negative metastatic breast cancer (MBC) is a common setting in which chemotherapy could be effective even in later lines of treatment. Oral etoposide has demonstrated clinical activity in this setting in small-scale studies, but its efficacy has not been compared to that of other chemotherapy regimens.
We used the ESME database (Epidemiological Strategy and Medical Economics), a real-life national French multicentre cohort of MBC patients initiating therapy between 1 January 2008 to 31 December 2014. HER2-negative MBC patients who received oral etoposide as > 3rd chemotherapy line and for more than 14 days were included. Primary objective was progression-free survival (PFS); secondary objectives were overall survival (OS), and propensity-score matched Cox models including comparison with other therapies in the same setting.
Three hundred forty-five out of 16,702 patients received oral etoposide and 222 were eligible. Median PFS was 3.2 months [95% CI 2.8-4] and median OS 7.3 months [95% CI 5.7-10.3]. Median PFS did not significantly differ according to the therapeutic line. The only prognostic factor for both PFS and OS was the MBC phenotype (hormone receptor-positive versus triple-negative, HR = 0.71 [95% CI 0.52-0.97], p = 0.028 for PFS and HR = 0.65 [0.46-0.92], p = 0.014 for OS). After matching for the propensity score, no differential effect on PFS or OS was observed between oral etoposide and other chemotherapy regimens administered in the same setting (HR = 0.94 [95% CI 0.77-1.15], p = 0.55 for PFS and HR = 1.10 [95% CI 0.88-1.37], p = 0.40 for OS).
Oral etoposide retains some efficacy in selected heavily pre-treated patients with HER2-negative MBC, with the advantages of oral administration.
HER2 阴性转移性乳腺癌（MBC）是一种常见的情况，即使在后续治疗中，化疗也可能有效。在小规模研究中，口服依托泊苷在这种情况下显示出了临床活性，但它的疗效尚未与其他化疗方案进行比较。
我们使用了 ESME 数据库（流行病学策略和医学经济学），这是一个真实的全国性法国多中心 MBC 患者队列，于 2008 年 1 月 1 日至 2014 年 12 月 31 日期间开始治疗。HER2 阴性 MBC 患者接受了口服依托泊苷作为>第 3 线化疗药物，并且治疗时间超过 14 天，被纳入研究。主要目标是无进展生存期（PFS）；次要目标是总生存期（OS），以及在同一治疗环境下与其他治疗方法进行倾向评分匹配 Cox 模型比较。
在 16702 名患者中，有 345 名接受了口服依托泊苷治疗，其中 222 名符合条件。中位 PFS 为 3.2 个月[95%CI 2.8-4]，中位 OS 为 7.3 个月[95%CI 5.7-10.3]。根据治疗线数，中位 PFS 无显著差异。唯一影响 PFS 和 OS 的预后因素是 MBC 表型（激素受体阳性与三阴性，HR=0.71[95%CI 0.52-0.97]，p=0.028 用于 PFS 和 HR=0.65[0.46-0.92]，p=0.014 用于 OS）。在进行倾向评分匹配后，口服依托泊苷与在同一治疗环境下使用的其他化疗方案在 PFS 或 OS 上没有观察到差异（HR=0.94[95%CI 0.77-1.15]，p=0.55 用于 PFS 和 HR=1.10[95%CI 0.88-1.37]，p=0.40 用于 OS）。
在选择的、经过大量预处理的 HER2 阴性 MBC 患者中，口服依托泊苷保留了一定的疗效，具有口服给药的优势。
