Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Medical Oncology, Breast Tumor Centre, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Division of Science and Technology, Beijing Normal University-Hong Kong Baptist University United International College, Hong Kong Baptist University, Zhuhai, China.
Cancer Res Treat. 2022 Oct;54(4):1038-1052. doi: 10.4143/crt.2021.698. Epub 2022 Feb 4.
This study aims to comprehensively evaluate the clinical efficacy of chemotherapy or endocrine therapy maintenance in metastatic breast cancer (MBC) patients.
The meta-analysis of randomized clinical trials (RCTs) and propensity score matching of multicenter cohort study evaluated MBC patients who underwent first-line chemotherapy or endocrine therapy maintenance. This study is registered with PROSPERO: CRD42017071858 and ClinicalTrials.gov: NCT04258163.
A total of 2,867 patients from 15 RCTs and 760 patients from multicenter cohort were included. The results from meta-analysis showed that chemotherapy maintenance improved progression-free survival (PFS) (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.54 to 0.73; p < 0.001; moderate-quality evidence) and overall survival (OS) (HR, 0.87; 95% CI 0.78 to 0.97; p=0.016; high-quality evidence) than observation. In the cohort study, for hormone receptor-positive MBC patients, chemotherapy maintenance improved PFS (HR, 0.67; 95% CI, 0.52 to 0.85; p < 0.001) and OS (HR, 0.55; 95% CI 0.42 to 0.73; p < 0.001) compared with observation, and endocrine therapy maintenance also improved PFS (HR, 0.65; 95% CI, 0.53 to 0.80; p < 0.001) and OS (HR, 0.55; 95% CI, 0.44 to 0.69; p < 0.001). There were no differences between chemotherapy and endocrine therapy maintenance in PFS and OS (all p > 0.05). Regardless of the continuum or switch maintenance therapy, showed prolonged survival in MBC patients who were response to first-line treatment.
This study provided evidences for survival benefits of chemotherapy and endocrine therapy maintenance in MBC patients, and there was no difference efficacy between chemotherapy and endocrine therapy maintenance for hormone receptor-positive patients.
本研究旨在全面评估转移性乳腺癌（MBC）患者接受化疗或内分泌治疗维持治疗的临床疗效。
对一线化疗或内分泌治疗维持的 MBC 患者进行随机临床试验（RCT）的荟萃分析和多中心队列研究的倾向评分匹配。本研究已在 PROSPERO 注册：CRD42017071858 和 ClinicalTrials.gov：NCT04258163。
共有 15 项 RCT 中的 2867 名患者和多中心队列中的 760 名患者纳入分析。荟萃分析结果显示，化疗维持治疗改善了无进展生存期（PFS）（风险比 [HR]，0.63；95%置信区间 [CI]，0.54 至 0.73；p<0.001；中等质量证据）和总生存期（OS）（HR，0.87；95%CI 0.78 至 0.97；p=0.016；高质量证据），优于观察组。在队列研究中，对于激素受体阳性的 MBC 患者，化疗维持治疗改善了 PFS（HR，0.67；95%CI，0.52 至 0.85；p<0.001）和 OS（HR，0.55；95%CI 0.42 至 0.73；p<0.001），而内分泌治疗维持也改善了 PFS（HR，0.65；95%CI，0.53 至 0.80；p<0.001）和 OS（HR，0.55；95%CI 0.44 至 0.69；p<0.001）。化疗和内分泌治疗维持在 PFS 和 OS 方面无差异（均 p>0.05）。无论采用连续性或转换维持治疗，在对一线治疗有反应的 MBC 患者中均显示出延长的生存。
本研究为 MBC 患者接受化疗和内分泌治疗维持治疗的生存获益提供了证据，并且对于激素受体阳性患者，化疗和内分泌治疗维持的疗效无差异。
