Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA.
Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Breast Cancer. 2024 Nov;31(6):1059-1070. doi: 10.1007/s12282-024-01618-x. Epub 2024 Aug 8.
There have been concerns about the use of tumor necrosis factor inhibitors (TNFi) for autoimmune disease in patients with recently diagnosed cancer. We assessed the survival of patients with rheumatoid arthritis (RA) and newly diagnosed early breast cancer (BC) treated with TNFi in the first two years after BC diagnosis.
We identified patients in two datasets: (1) Optum's de-identified Clinformatics Data Mart Database (CDM), (2) Surveillance, Epidemiology, and End Results program (SEER) and Texas Cancer Registry (TCR) Medicare-linked cohort. We grouped patients according to whether they received TNFi, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) only, or no DMARDs within 2 years after BC. Outcomes were overall survival (OS) and BC-specific survival (BCSS). We conducted landmark analyses at years 1 and 2, with multivariable Cox regressions using propensity scores for adjustment.
In the first year after BC, 165/970 (17.0%) and 201/1246 (16.1%) patients received TNFi in CDM and SEER/TCR-Medicare respectively. In the 1 year landmark, no significant differences in OS were observed between patients treated with TNFi and patients treated with csDMARDs only in CDM (hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.42-1.40) or SEER/TCR-Medicare (HR = 0.84, 95% CI 0.54-1.31). BCSS (SEER/TCR-Medicare) was better in patients receiving TNFi than in those receiving csDMARDs only (HR = 0.28, 95% CI 0.08-0.98). In CDM, glucocorticoid therapy had worse OS than those without glucocorticoids (HR = 2.18, 95% CI 1.13-4.18). This was also observed in SEER/TCR-Medicare (not statistically significant). Similar results were observed for the 2 year landmark.
TNFi treatment during the first two years after early BC was not associated with worse survival.
人们一直担心肿瘤坏死因子抑制剂（TNFi）在近期诊断出癌症的患者中用于治疗自身免疫性疾病的安全性。我们评估了在乳腺癌（BC）诊断后两年内接受 TNFi 治疗的类风湿关节炎（RA）患者的生存情况。
我们在两个数据集（1）Optum 的去识别 Clinformatics Data Mart 数据库（CDM）和（2）监测、流行病学和最终结果计划（SEER）和德克萨斯癌症登记处（TCR）医疗保险相关队列中识别了患者。我们根据患者在 BC 后 2 年内是否接受 TNFi、传统合成疾病修饰抗风湿药物（csDMARDs）或无 DMARD 治疗进行分组。结局是总生存（OS）和 BC 特异性生存（BCSS）。我们在第 1 年和第 2 年进行了里程碑分析，使用倾向评分进行多变量 Cox 回归调整。
在 BC 后第一年，CDN 中分别有 165/970（17.0%）和 SEER/TCR-医疗保险中分别有 201/1246（16.1%）的患者接受了 TNFi 治疗。在 1 年的时间点，CDN 中接受 TNFi 治疗的患者与仅接受 csDMARDs 治疗的患者之间的 OS 无显著差异（HR=0.77，95%CI 0.42-1.40）或 SEER/TCR-医疗保险（HR=0.84，95%CI 0.54-1.31）。接受 TNFi 治疗的患者的 BCSS（SEER/TCR-医疗保险）优于仅接受 csDMARDs 治疗的患者（HR=0.28，95%CI 0.08-0.98）。在 CDN 中，糖皮质激素治疗的患者 OS 较未接受糖皮质激素治疗的患者差（HR=2.18，95%CI 1.13-4.18）。这在 SEER/TCR-医疗保险中也观察到（无统计学意义）。在 2 年的时间点也观察到了类似的结果。
在早期 BC 后两年内接受 TNFi 治疗与生存状况恶化无关。
