Kim Ji-Yeon, Shin Junghoon, Ahn Jin Seok, Park Yeon Hee, Im Young-Hyuck
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Department of Health Science & Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Cancers (Basel). 2023 Jun 30;15(13):3431. doi: 10.3390/cancers15133431.
We analyzed real-world practice of second-line treatment in hormone receptor (HR)+ human epidermal growth factor receptor-2 (HER2)- metastatic breast cancer (MBC) following the first-line CDK4/6 inhibitor with letrozole. In addition, we evaluated the relationship between second-line treatment strategies and survival outcome.
Using the clinical data warehouse, clinical information including MBC diagnosis, treatment and survival outcomes were collected.
In total, 305 patients were treated with the first-line palbociclib plus letrozole, and we evaluated 166 patients who were treated with second-line treatment. Of the 166 patients, 28.5% were treated with capecitabine (C), followed by exemestane with everolimus (EE) (27.3%) or cytotoxic chemotherapy other than capecitabine (T) (18.8%) and fulvestrant-based treatment or endocrine monotherapy (F) (12.7%). Eighteen patients (10.9%) were enrolled in clinical trials (CT). With regard to treatment strategies, and the median progression-free survival of second-line treatment in a metastatic setting (PFS2) was 7.4 months with C, 5.2 months with EE, 4.8 months with T, 3.6 months with F, and 3.6 months with CT ( = 0.066). In patients with visceral organ disease progression, C (31.3%) or T(31.3%) was the most common second-line treatment followed by EE (21.9%). Most of the 47 patients with bone metastasis alone were treated with EE (38.2%), followed by C (23.4%) and F (21.3%) ( = 0.008). The median overall survival of second-line treatment in a metastatic setting (OS2) was 42.3 months with C, 35.7 months with F, 30.7 months with EE, and 23.1 months with T. The median OS2 for those in CT was not reached ( = 0.064). ER driven BC, disease progression site and PFS2 were associated with OS and OS2 in HR+HER2- MBC ( < 0.05).
We suggested the second line treatment strategy was important to improve prognosis in patients with HR+/HER2- MBC, especially given the recent standardization of first-line treatment and the many available second-line options.
我们分析了在一线使用CDK4/6抑制剂联合来曲唑治疗后，激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性的转移性乳腺癌（MBC）患者的二线治疗实际情况。此外，我们评估了二线治疗策略与生存结局之间的关系。
利用临床数据仓库，收集包括MBC诊断、治疗和生存结局等临床信息。
共有305例患者接受了一线哌柏西利联合来曲唑治疗，我们评估了166例接受二线治疗的患者。在这166例患者中，28.5%接受了卡培他滨（C）治疗，其次是依西美坦联合依维莫司（EE）（27.3%）或除卡培他滨外的细胞毒性化疗（T）（18.8%）以及氟维司群为基础的治疗或内分泌单药治疗（F）（12.7%）。18例患者（10.9%）参加了临床试验（CT）。关于治疗策略，转移性环境下二线治疗的中位无进展生存期（PFS2），C组为7.4个月，EE组为5.2个月，T组为4.8个月，F组为3.6个月，CT组为3.6个月（P = 0.066）。在内脏器官疾病进展的患者中，C（31.3%）或T（31.3%）是最常见的二线治疗，其次是EE（21.9%）。47例仅发生骨转移的患者中，大多数接受了EE治疗（38.2%），其次是C（23.4%）和F（21.3%）（P = 0.008）。转移性环境下二线治疗的中位总生存期（OS2），C组为42.3个月，F组为35.7个月，EE组为30.7个月，T组为23.1个月。CT组患者的中位OS2未达到（P = 0.064）。雌激素受体驱动的乳腺癌、疾病进展部位和PFS2与HR+HER2- MBC患者的OS和OS2相关（P < 0.05）。
我们认为二线治疗策略对于改善HR+/HER2- MBC患者的预后很重要，尤其是考虑到一线治疗的近期标准化以及众多可用的二线治疗选择。
