Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), Milan, Italy.
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
Clin Breast Cancer. 2019 Apr;19(2):e306-e318. doi: 10.1016/j.clbc.2018.12.004. Epub 2018 Dec 12.
Single-agent gemcitabine is a moderately effective compound in metastatic breast cancer (mBC) treatment. Carboplatin is frequently used in addition to gemcitabine to improve tumor responses, but with an unclear effect on survival outcomes. In this study we evaluated the antitumor efficacy and safety profiles of gemcitabine and carboplatin-gemcitabine in mBC patients.
We retrospectively collected data on patients treated between April 2012 and February 2018 with gemcitabine 800 mg/mor carboplatin at an area under the curve of 2 with gemcitabine 800 mg/m, given on days 1 and 8 every 21 days. We compared progression-free survival (PFS), objective response rate (ORR), overall survival, and incidence of adverse events (AEs) in the 2 cohorts.
Of 163 consecutive patients who met the inclusion criteria, 75 received gemcitabine and 88 carboplatin-gemcitabine. Patients in the combination cohort had received a lower number of previous chemotherapy lines (2 vs. 3), and were less likely to have received carboplatin (9 patients [10%] vs. 34 patients [45%]; P < .0001). We found no PFS differences in carboplatin-gemcitabine and gemcitabine cohorts (4.24 vs. 4.61 months; adjusted hazard ratio, 0.98; P = .92), whereas the combination was associated with a trend toward higher ORR (18 patients [20.4%] vs. 8 patients [10.6%]; P = .089) and with significantly higher incidence of Grade 3/4 neutropenia (30 patients [34%] vs. 5 patients [6.6%]; P < .0001).
Using carboplatin in addition to gemcitabine is associated with more hematologic AEs but not with better PFS. Although single-agent gemcitabine remains a treatment option for heavily pretreated mBC patients, finding biomarkers of response to platinum salts might help to identify patients more likely to benefit from carboplatin-gemcitabine.
单药吉西他滨在转移性乳腺癌（mBC）治疗中是一种中度有效的化合物。卡铂常与吉西他滨联合使用以提高肿瘤反应率，但对生存结果的影响尚不清楚。在这项研究中，我们评估了吉西他滨和吉西他滨联合卡铂在 mBC 患者中的抗肿瘤疗效和安全性。
我们回顾性收集了 2012 年 4 月至 2018 年 2 月期间接受吉西他滨 800mg/m 或卡铂（曲线下面积为 2）联合吉西他滨 800mg/m 治疗的患者的数据，每 21 天使用一次，吉西他滨和卡铂分别在第 1 天和第 8 天使用。我们比较了两个队列的无进展生存期（PFS）、客观缓解率（ORR）、总生存期和不良事件（AE）发生率。
在符合纳入标准的 163 例连续患者中，75 例接受吉西他滨治疗，88 例接受吉西他滨联合卡铂治疗。联合组患者接受的化疗线数较少（2 线 vs. 3 线），且接受卡铂治疗的可能性较小（9 例[10%] vs. 34 例[45%]；P <.0001）。我们发现卡铂联合吉西他滨和吉西他滨两组之间的 PFS 无差异（4.24 个月 vs. 4.61 个月；调整后危险比，0.98；P =.92），但联合治疗与更高的 ORR 趋势相关（18 例[20.4%] vs. 8 例[10.6%]；P =.089），且中性粒细胞 3/4 级毒性的发生率显著升高（30 例[34%] vs. 5 例[6.6%]；P <.0001）。
吉西他滨联合卡铂治疗除了会引起更多血液学毒性外，对 PFS 没有更好的影响。虽然单药吉西他滨仍然是治疗大量预处理过的 mBC 患者的一种治疗选择，但寻找对铂盐有反应的生物标志物可能有助于识别更有可能从卡铂联合吉西他滨中受益的患者。
