Department of Oncology No. 4 Ward, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing 100071, China.
Department of Oncology No. 3 Ward, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing 100071, China.
Chin Med J (Engl). 2023 Jun 20;136(12):1459-1467. doi: 10.1097/CM9.0000000000002676. Epub 2023 Apr 27.
Endocrine therapy (ET) and ET-based regimens are the preferred first-line treatment options for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (HR+/HER2- MBC), while chemotherapy (CT) is commonly used in clinical practice. The aim of this study was to investigate the efficacy and clinical outcome of ET and CT as first-line treatment in Chinese patients with HR+/HER2- MBC.
Patients diagnosed with HR+/HER2-MBC between January 1st, 1996 and September 30th, 2018 were screened from the Chinese Society of Clinical Oncology Breast Cancer database. The initial and maintenance first-line treatment, progression-free survival (PFS), and overall survival (OS) were analyzed.
Among the 1877 included patients, 1215 (64.7%) received CT and 662 (35.3%) received ET as initial first-line treatment. There were no statistically significant differences in PFS and OS between patients receiving ET and CT as initial first-line treatment in the total population (PFS: 12.0 vs. 11.0 months, P = 0.22; OS: 54.0 vs . 49.0 months, P =0.09) and propensity score matched population. For patients without disease progression after at least 3 months of initial therapy, maintenance ET following initial CT (CT-ET cohort, n = 449) and continuous schedule of ET (ET cohort, n = 527) had longer PFS than continuous schedule of CT (CT cohort, n = 406) in the total population (CT-ET cohort vs. CT cohort: 17.0 vs . 8.5 months; P <0.01; ET cohort vs . CT cohort: 14.0 vs . 8.5 months; P <0.01) and propensity score matched population. OS in the three cohorts yielded the same results as PFS.
ET was associated with similar clinical outcome to CT as initial first-line treatment. For patients without disease progression after initial CT, switching to maintenance ET showed superiority in clinical outcome over continuous schedule of CT.
内分泌治疗（ET）和基于 ET 的方案是激素受体（HR）阳性和人表皮生长因子受体 2（HER2）阴性转移性乳腺癌（HR+/HER2-MBC）的首选一线治疗选择，而化疗（CT）在临床实践中通常被使用。本研究旨在探讨 ET 和 CT 作为中国 HR+/HER2-MBC 患者一线治疗的疗效和临床结局。
从中国临床肿瘤学会乳腺癌数据库中筛选 1996 年 1 月 1 日至 2018 年 9 月 30 日期间诊断为 HR+/HER2-MBC 的患者。分析初始和维持一线治疗、无进展生存期（PFS）和总生存期（OS）。
在纳入的 1877 例患者中，1215 例（64.7%）接受 CT 作为初始一线治疗，662 例（35.3%）接受 ET 作为初始一线治疗。在总人群和倾向评分匹配人群中，接受 ET 和 CT 作为初始一线治疗的患者的 PFS 和 OS 无统计学差异（PFS：12.0 与 11.0 个月，P=0.22；OS：54.0 与 49.0 个月，P=0.09）。对于初始治疗至少 3 个月后无疾病进展的患者，在初始 CT 后维持 ET（CT-ET 队列，n=449）和持续 ET 方案（ET 队列，n=527）的 PFS 长于持续 CT 方案（CT 队列，n=406）（CT-ET 队列与 CT 队列：17.0 与 8.5 个月；P<0.01；ET 队列与 CT 队列：14.0 与 8.5 个月；P<0.01）和倾向评分匹配人群。三个队列的 OS 与 PFS 结果一致。
ET 作为初始一线治疗与 CT 具有相似的临床结局。对于初始 CT 后无疾病进展的患者，转为维持 ET 治疗在临床结局方面优于持续 CT 方案。
