CDK4/6 抑制剂治疗后疾病进展的激素阳性晚期乳腺癌患者后续治疗的疗效。
Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.
机构信息
Department of Medical Oncology, UHS Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Department of Medical Oncology, Sakarya University, Sakarya, Turkey.
出版信息
BMC Cancer. 2023 Feb 10;23(1):136. doi: 10.1186/s12885-023-10609-8.
BACKGROUND
There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based).
METHODS
A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy.
RESULTS
The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months.
CONCLUSION
Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.
背景
国际指南中对于 CDK4/6 抑制剂（CDKi）治疗后，没有推荐用于后续治疗的标准治疗类别 1 级。我们旨在评估在 CDKi 治疗下疾病进展的患者中，肿瘤学家更倾向于哪种后续治疗。此外，我们旨在展示 CDKi 后系统治疗的有效性，以及激素治疗（单药治疗与 mTOR 为基础的治疗）之间是否存在生存差异。
方法
共有 53 个中心的 609 名患者纳入研究。计算了 CDKi 后后续治疗（化疗（CT，n：434）或内分泌治疗（ET，n：175））的无进展生存期（PFS）。根据 ET 和 CT 的使用情况，患者被评估为三组：一线治疗中接受 CDKi 的患者（组 A，n：202）、二线治疗中接受 CDKi 的患者（组 B，n：153）和≥三线治疗中接受 CDKi 的患者（组 C，n：254）。根据 ET 和 CT 的使用情况比较了 PFS。此外，将 ET 作为单药治疗与 everolimus 为基础的联合治疗进行了比较。
结果
在组 A、B 和 C 的 ET 臂中，CDKi 的中位持续时间分别为 17.0、11.0 和 8.5 个月；在 CT 臂中，分别为 9.0、7.0 和 5.0 个月。在 ET 臂中，CDKi 后的中位 PFS 在组 A 中为 9.5（5.0-14.0）个月，在 CT 臂中为 5.3（3.9-6.8）个月（p=0.073）。在 ET 臂中，组 B 为 6.7（5.8-7.7）个月，在 CT 臂中为 5.7（4.6-6.7）个月（p=0.311）。在 ET 臂中，组 C 为 5.3（2.5-8.0）个月，在 CT 臂中为 4.0（3.5-4.6）个月（p=0.434）。在 CDKi 后接受 ET 的患者中，与接受 everolimus 为基础的联合治疗的患者相比，接受单药 ET 治疗的患者的中位 PFS 在组 A、B 和 C 中分别为 11.0 比 5.9（p=0.047）、6.7 比 5.0（p=0.164）、6.7 比 3.9（p=0.763）个月。
结论
在 CDKi 早期进展的患者中，医生更倾向于 CT 而非 ET。已经表明，CDKi 后 ET 可以与 CT 一样有效。与单药 ET 治疗相比，在一线 CDKi 后接受 everolimus 为基础的治疗后，观察到更好的 PFS 可能。
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