Krajnak Slavomir, Krajnakova Jana, Anic Katharina, Almstedt Katrin, Heimes Anne-Sophie, Linz Valerie Catherine, Loewe Amelie, Schmidt Mona Wanda, Hasenburg Annette, Schmidt Marcus, Battista Marco Johannes
Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Breast Care (Basel). 2023 May;18(2):97-105. doi: 10.1159/000528042. Epub 2023 Jan 9.
Metronomic chemotherapy (MCT) is increasingly used in oncology due to its favorable therapeutic index. There is still a lack of evidence for MCT in metastatic breast cancer (MBC). In this retrospective unicenter study, we demonstrated real-word data on MCT in MBC.
MBC patients who received metronomic oral cyclophosphamide (CTX) (50 mg daily) and methotrexate (MTX) (2.5 mg every other day), CTX and capecitabine (CAPE) (500 mg thrice daily), CTX, or vinorelbine (VRL) (30 mg daily) alone for at least 4 weeks between 2009 and 2021 were included. The primary endpoint was disease control rate (DCR) ≥24 weeks. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Patient characteristics and therapy response were analyzed using χ test. For survival analyses, Kaplan-Meier estimator and log-rank test were used.
Seventy-two patients were identified. Sixty-two patients received CTX/MTX, three CTX/CAPE, two CTX, and five VRL. Median age at diagnosis MBC and at start of MCT was 59.0 years and 64.5 years, respectively. 72.2% tumors were hormone receptor positive and 27.8% were triple-negative. 54.2% patients had more than two different metastases. 80.6% patients showed visceral involvement. 31.9% patients achieved DCR ≥24 weeks. Median PFS was 17.0 weeks (95% CI 14.5-19.5) and median OS was 58.0 weeks (95% CI 29.0-87.0). MCT showed similar DCR ≥24 weeks and clinically meaningful but not statistically significant shorter median PFS compared to prior therapy (31.9% versus 32.8% [ = 0.570] and 17.0 weeks versus 20.0 weeks [ = 0.093], respectively) and statistically significant higher DCR ≥24 weeks and longer median PFS compared to subsequent therapy (31.9% versus 17.4% [ = 0.038] and 17.0 weeks versus 12.0 weeks [ = 0.006], respectively). Three (4.2%) patients terminated MCT because of toxicity.
In this real-world retrospective study, MCT was effective and well tolerated and may thus represent a valuable treatment option in selected MBC patients.
节拍化疗（MCT）因其良好的治疗指数而在肿瘤学中越来越多地被使用。转移性乳腺癌（MBC）中MCT的证据仍然不足。在这项回顾性单中心研究中，我们展示了MBC中MCT的真实世界数据。
纳入2009年至2021年间接受口服节拍环磷酰胺（CTX）（每日50mg）和甲氨蝶呤（MTX）（隔日2.5mg）、CTX和卡培他滨（CAPE）（每日三次，每次500mg）、CTX或长春瑞滨（VRL）（每日30mg）单药治疗至少4周的MBC患者。主要终点是疾病控制率（DCR）≥24周。次要终点是无进展生存期（PFS）和总生存期（OS）。使用χ检验分析患者特征和治疗反应。生存分析采用Kaplan-Meier估计器和对数秩检验。
共纳入72例患者。62例患者接受CTX/MTX，3例接受CTX/CAPE，2例接受CTX，5例接受VRL。MBC诊断时和MCT开始时的中位年龄分别为59.0岁和64.5岁。72.2%的肿瘤为激素受体阳性，27.8%为三阴性。54.2%的患者有两种以上不同转移灶。80.6%的患者有内脏受累。31.9%的患者达到DCR≥24周。中位PFS为17周（95%CI 14.5-19.5），中位OS为58周（95%CI 29.0-87.0）。与先前治疗相比，MCT显示DCR≥24周相似，中位PFS在临床上有意义但无统计学差异（分别为31.9%对32.8%[P = 0.570]和17.0周对20.0周[P = 0.093]），与后续治疗相比，DCR≥24周有统计学显著差异且中位PFS更长（分别为31.9%对17.4%[P = 0.038]和17.0周对12.0周[P = 0.006]）。3例（4.2%）患者因毒性终止MCT。
在这项真实世界回顾性研究中，MCT有效且耐受性良好，因此可能是部分MBC患者的一种有价值的治疗选择。
