Genesys Hurley Cancer Institute, Flint, MI.
Genesys Research Office, Ascension Genesys, Grand Blanc, MI.
Clin Breast Cancer. 2019 Jun;19(3):e475-e480. doi: 10.1016/j.clbc.2019.01.012. Epub 2019 Feb 7.
Anthracyclines are associated with significant toxicities whereas nonanthracyclines have proven to be better tolerated. A 21-gene assay allows clinicians to predict who will not benefit from adjuvant chemotherapy and avoid systemic toxicities. Physicians are using the recurrence score to guide chemotherapy selection, despite the lack of evidence. In this study we examined factors associated with prescribing patterns for an anthracycline-based chemotherapy in hormone receptor-positive stage I to III breast cancer.
This was a retrospective study using the Michigan Breast Oncology Quality Initiative data set (February 1, 2006 to December 31, 2015). Women with histologically confirmed stage I to III invasive breast cancer with estrogen receptor and/or progesterone receptor-positive, HER2/neu-negative receptor status were included. We used χ analysis to determine associations of these characteristics with the 21-gene assay score and anthracycline use.
A total of 17,788 patients were evaluated. Most tumors were stage I (60%). Most procedures were lumpectomy with radiation (66%). Anthracyclines were used more often in stage III patients (69%), younger patients (40% for patients younger than 65 years), and those with higher 21-gene recurrence scores. Patients with low recurrence scores were more likely to receive anthracyclines if lymph node-positive (10%) than if lymph node-negative (1%; P < .001). Patients with high recurrence scores and lymph node-positive status were just as likely to receive an anthracycline-based as a nonanthracycline-based regimen (47.5% vs. 49.2%; P = .89).
These data indicate that medical oncologists might be anticipating the results of Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer study (TAILORx) and the Clinical Outcomes in ER+HER2-node-positive Breast Cancer Patients Who Were Treated According to the Recurrence Score Results: Evidence From a Large Prospectively Designed Registry (RxPonder) trials and are avoiding the potential serious complications associated with anthracycline treatment in patients least likely to receive benefit.
蒽环类药物与显著的毒性相关，而非蒽环类药物已被证明更能耐受。21 基因检测可帮助临床医生预测哪些患者不能从辅助化疗中获益，并避免全身性毒性。尽管缺乏证据，医生仍在使用复发评分来指导化疗选择。在这项研究中，我们研究了与激素受体阳性 I 期至 III 期乳腺癌患者接受蒽环类药物为基础的化疗方案相关的因素。
这是一项使用密歇根州乳腺癌肿瘤质量倡议数据集（2006 年 2 月 1 日至 2015 年 12 月 31 日）的回顾性研究。入组标准为组织学证实的 I 期至 III 期浸润性乳腺癌患者，雌激素受体和/或孕激素受体阳性，HER2/neu 阴性受体状态。我们使用 χ2 分析来确定这些特征与 21 基因检测评分和蒽环类药物使用之间的关联。
共评估了 17788 例患者。大多数肿瘤为 I 期（60%）。大多数手术为保乳术加放疗（66%）。蒽环类药物在 III 期患者（69%）、年轻患者（40%为<65 岁患者）和 21 基因复发评分较高的患者中更常使用。低复发评分患者如果淋巴结阳性（10%），比淋巴结阴性（1%；P<0.001）更有可能接受蒽环类药物治疗。高复发评分且淋巴结阳性的患者接受蒽环类药物或非蒽环类药物方案的可能性相同（47.5% vs. 49.2%；P=0.89）。
这些数据表明，肿瘤内科医生可能正在预测 Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer study（TAILORx）和 Clinical Outcomes in ER+HER2-node-positive Breast Cancer Patients Who Were Treated According to the Recurrence Score Results: Evidence From a Large Prospectively Designed Registry（RxPonder）试验的结果，并避免在不太可能受益的患者中使用蒽环类药物治疗的潜在严重并发症。
