Division of Hematology-Oncology, Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
BMC Cancer. 2019 Jan 17;19(1):84. doi: 10.1186/s12885-018-5258-9.
In this study, we observe the patterns initial palliative treatment for premenopausal patients with HR-positive/HER2-negative MBC and determine if nonadherence to clinical guidelines are associated with worse clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) in the South Korean population.
A retrospective review was performed for premenopausal patients diagnosed with HR-positive/HER2-negative MBC between October 1997 and May 2016 who received palliative systemic treatments at a large tertiary medical center. Survival outcomes were analyzed according to the palliative treatment received prior to disease progression.
The review identified a total of 272 premenopausal patients meeting study criteria, whose median age was 39 years. Endocrine therapy was the initial treatment in 137 patients (Group 1) with chemotherapy as initial treatment in 135 patients. In the latter group, chemotherapy was continued in 78 patients (Group 2), whereas chemotherapy was switched to endocrine treatment in 57 patients prior to any disease progression (Group 3). Both PFS and OS were significantly longer for chemotherapy-endocrine therapy (median PFS 18.2 months and OS 85.2 months) than for chemotherapy-alone (median PFS 12.6 months and OS 45.5 months) or endocrine therapy-alone (median PFS 7.0 months and OS 57.3 months) (all p values < 0.01). In multivariate analysis, chemotherapy-endocrine therapy was an independent predictive value for improved PFS and OS (hazard ratio [HR] 0.33, 95% CI 0.20-0.52, p < 0.001; HR 0.38, 95% CI 0.19-0.73, p = 0.004).
In our study population, chemotherapy alone was not objectively inferior to endocrine therapy as the initial palliative treatment. In addition, chemotherapy followed by endocrine therapy was associated with objective higher response rate than endocrine therapy alone. Further studies should explore the relationship between non-adherent treatment patterns and patient outcomes across the largely premenopausal breast cancer populations across Asian countries.
本研究观察了绝经前 HR 阳性/HER2 阴性转移性乳腺癌（MBC）患者初始姑息治疗的模式，并确定在韩国人群中，非依从临床指南与无进展生存期（PFS）和总生存期（OS）的临床结局较差是否相关。
对 1997 年 10 月至 2016 年 5 月期间在一家大型三级医疗中心接受姑息性全身治疗的绝经前 HR 阳性/HER2 阴性 MBC 患者进行回顾性审查。根据疾病进展前接受的姑息治疗分析生存结局。
共纳入 272 例符合研究标准的绝经前患者，中位年龄为 39 岁。137 例患者接受内分泌治疗作为初始治疗（第 1 组），135 例患者接受化疗作为初始治疗（第 2 组）。在后一组中，78 例患者继续接受化疗（第 2 组），而 57 例患者在任何疾病进展之前将化疗转换为内分泌治疗（第 3 组）。与化疗单药治疗（中位 PFS 12.6 个月和 OS 45.5 个月）或内分泌单药治疗（中位 PFS 7.0 个月和 OS 57.3 个月）相比，化疗联合内分泌治疗的 PFS 和 OS 均显著延长（所有 p 值均<0.01）。多变量分析显示，化疗联合内分泌治疗是改善 PFS 和 OS 的独立预测因素（风险比 [HR] 0.33，95%CI 0.20-0.52，p<0.001；HR 0.38，95%CI 0.19-0.73，p=0.004）。
在我们的研究人群中，化疗单独治疗并不劣于内分泌治疗作为初始姑息治疗。此外，与单独内分泌治疗相比，化疗后联合内分泌治疗的客观缓解率更高。应进一步研究非依从性治疗模式与亚洲国家绝经前乳腺癌人群患者结局之间的关系。
