Wu Yun, Han Yiqun, Yu Pei, Ouyang Quchang, Yan Min, Wang Xiaojia, Hu Xichun, Jiang Zefei, Huang Tao, Tong Zhongsheng, Wang Shusen, Yin Yongmei, Li Hui, Yang Runxiang, Yang Huawei, Teng Yuee, Sun Tao, Cai Li, Li Hongyuan, Chen Xi, He Jianjun, Liu Xinlan, Yang Shune, Qiao Youlin, Fan Jinhu, Wang Jiayu, Xu Binghe
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Feb 11;10:599604. doi: 10.3389/fonc.2020.599604. eCollection 2020.
Clinical guidelines generally recommend endocrine therapy (ET) as first-line treatment of hormone receptor-positive advanced breast cancer (HR+ ABC) whereas chemotherapy (CT) should be considered in the presence of life-threatening disease or limited clinical benefit after three sequential ET regimens. However, it is unclear if real-world clinical practice is in accordance with the current guidelines. This study was to present the real-world treatment patterns and ET regimens among HR+ ABC patients in China.
Using data from the Nation-wide Multicenter Retrospective Clinical Epidemiology Study of Female Advanced Breast Cancer in China (ClinicalTrials.gov identifier: NCT03047889), we investigated the clinicopathological characteristics, clinical profiles, and treatment patterns of HR+ ABC patients from January 2012 to December 2014.
A total of 2,342 patients with HR+ ABC were included in this study. Our findings revealed that, in comparisons with those receiving initial CT (n = 1445), patients initiated ET (n =402) were significantly older, later recurrent after adjuvant treatment, with a lower rate of visceral involvement and a decreasing quantity of metastatic sites. A total of 1,308 patients received palliative ET while only 18.9% patients (n = 247) reached three lines of ET. Among patients completing more than one line of ET, the median treatment duration was 8 months for the first line, 6 months for the second line, and 3 months for the third line for patients receiving ET. In the advanced setting, the choices of palliative ET regimens were diverse, yet aromatase inhibitor (AI) monotherapy was still the overall mainstay of ET; in contrast, patients were less accessible to everolimus plus AI regimen in this population.
Less than one quarter of patients initiated palliative ET for HR+ ABC in routine clinical practice. Patients who received multi-lines of ET experienced successive shorter durations following each line of therapy. This real-life data provides a solid overview of ET for HR+ ABC from China, indicating unmet need for treatment options that improve the effectiveness of endocrine therapy.
临床指南通常推荐内分泌治疗（ET）作为激素受体阳性晚期乳腺癌（HR+ABC）的一线治疗方法，而在存在危及生命的疾病或经过三种连续ET方案后临床获益有限的情况下，应考虑化疗（CT）。然而，尚不清楚实际临床实践是否符合当前指南。本研究旨在呈现中国HR+ABC患者的实际治疗模式和ET方案。
利用中国女性晚期乳腺癌全国多中心回顾性临床流行病学研究（ClinicalTrials.gov标识符：NCT03047889）的数据，我们调查了2012年1月至2014年12月期间HR+ABC患者的临床病理特征、临床概况和治疗模式。
本研究共纳入2342例HR+ABC患者。我们的研究结果显示，与接受初始CT的患者（n = 1445）相比，开始ET治疗的患者（n = 402）年龄显著更大，辅助治疗后复发更晚，内脏受累率更低，转移部位数量减少。共有1308例患者接受了姑息性ET治疗，而只有18.9%的患者（n = 247）接受了三线ET治疗。在完成多于一线ET治疗的患者中，接受ET治疗的患者一线治疗的中位持续时间为8个月，二线为6个月，三线为3个月。在晚期情况下，姑息性ET方案的选择多种多样，但芳香化酶抑制剂（AI）单药治疗仍然是ET的总体主要治疗方法；相比之下，该人群中接受依维莫司联合AI方案的患者较少。
在常规临床实践中，不到四分之一的HR+ABC患者开始接受姑息性ET治疗。接受多线ET治疗的患者在每一线治疗后的持续时间依次缩短。这些真实世界的数据提供了中国HR+ABC患者ET治疗情况的全面概述，表明对改善内分泌治疗效果的治疗选择存在未满足的需求。
