Fabi Alessandra, Ciccarese Mariangela, Scagnoli Sinome, Russillo Michelangelo, Schettini Francesco, Buono Giuseppe, Lorusso Vito, Cannita Katia, Arpino Grazia, Stani Simonetta, Palleschi Michela, Rossello Rosalba, Sarobba Giuseppina, Fabbri Agnese, Giampaglia Marianna, Pellegrini Patrizia, Adamo Vincenzo, Morelli Francesca, Barberi Vittoria, Ferretti Gianluigi, Catania Giovanna, Pisegna Simona, Cognetti Francesco, Giannarelli Diana
Oncology. 2021 Dec 7. doi: 10.1159/000521252.
To date, a consensus has not yet been reached about the therapy sequence after disease progression (PD) on CDK4/6 inhibitors in patients with HR+/HER2- metastatic breast cancer (MBC).
The present study assesses, in a real-world setting, the activity of different subsequent therapies in patients who experienced a PD on palbociclib (P) + endocrine therapy (ET), to evaluate the best therapy sequence.
This is a multicenter retrospective observational study. Records of consecutive HR+/HER2- MBC patients from January 2017 to May 2019 were reviewed. The primary endpoint was the evaluation of progression-free survival (PFS) according to subsequent treatment lines after progression on P+ET. Toxicity data were also collected.
The outcomes were analyzed in 89 MBC patients that had progressed on previous P+ET: 17 patients were on hormone therapy (HT) and 31 patients on chemotherapy (CT) as second-line treatments; seven patients were on HT and 34 on CT as third-line therapies. PFS of patients treated with HT as second-line therapy is significantly improved when compared with patients treated with CT (p=0.01). Considering third-line settings, the difference in PFS was not statistically different between HT and CT. A better outcome in terms of toxicity is observed among HT patients for both second- and third-line therapies.
patients who were progressive on P+ET could still benefit from a subsequent ET. In patients who experienced a good efficacy from prior ET, without visceral metastatic sites, HT seems the most suitable option, when compared to CT, also in terms of safety.
迄今为止，对于激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）转移性乳腺癌（MBC）患者在疾病进展（PD）后接受CDK4/6抑制剂治疗的后续治疗顺序尚未达成共识。
本研究在真实世界环境中评估了接受哌柏西利（P）+内分泌治疗（ET）后疾病进展的患者接受不同后续治疗的活性，以评估最佳治疗顺序。
这是一项多中心回顾性观察研究。回顾了2017年1月至2019年5月连续的HR+/HER2- MBC患者的记录。主要终点是根据P+ET进展后的后续治疗线评估无进展生存期（PFS）。还收集了毒性数据。
对89例先前接受P+ET治疗后病情进展的MBC患者的结果进行了分析：17例患者接受激素治疗（HT）作为二线治疗，31例患者接受化疗（CT）作为二线治疗；7例患者接受HT作为三线治疗，34例患者接受CT作为三线治疗。与接受CT治疗的患者相比，接受HT作为二线治疗的患者的PFS有显著改善（p=0.01）。考虑三线治疗情况，HT和CT之间的PFS差异无统计学意义。在二线和三线治疗中，HT患者的毒性结果更好。
接受P+ET治疗后病情进展的患者仍可从后续的ET中获益。对于先前接受ET治疗疗效良好且无内脏转移部位的患者，与CT相比，HT似乎是最合适的选择，在安全性方面也是如此。
