Almekinders Cornelia A M, Lin Lishi, Beijnen Jos H, Sonke Gabe S, Huitema Alwin D R, Dezentjé Vincent O
Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
University of Amsterdam, Amsterdam, The Netherlands.
Breast Cancer Res Treat. 2025 Feb;210(1):115-124. doi: 10.1007/s10549-024-07542-0. Epub 2024 Nov 7.
Palliative treatment options for HR + HER2- advanced breast cancer (ABC) patients have increased, but data is lacking about the optimal treatment sequence. We used real-world data from a comprehensive cancer center to describe applied treatment sequences and we determined treatment-related and survival outcomes.
Patients aged 18 years and older with HR + HER2- ABC treated with systemic treatment were included in this historic cohort study. Sequential treatment schedules, time to treatment discontinuation, time to chemotherapy, and overall survival (OS) were determined, stratified by first-line treatment.
202 patients were included. They received a total of 650 treatment lines (median 3; range: 1-11). 91 (45%), 25 (12%), 24 (12%), 28 (14%), 22 (11%) and 12 (6%) patients started first-line treatment with non-steroidal aromatase inhibitors (NSAI), NSAI + cyclin dependent kinase 4/6-inhibitors (CDK4/6i), fulvestrant + CDK4/6i, tamoxifen, chemotherapy and other treatment, respectively. 10, 13, and 14 different treatment regimens were given in first, second and third-line, respectively. Of the patients who started first-line NSAI monotherapy (n = 91), 3 (3%) died before receiving second-line treatment.
In this real-world cohort, we observed a wide variety of different treatment sequences applied in daily clinical practice, some of which were in discordance with the current guidelines. Fear that patients may never get around to treatment with CDK4/6i if a patient did not start with a CDK4/6i was not supported by our study results.
激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性的晚期乳腺癌（ABC）患者的姑息治疗选择有所增加，但缺乏关于最佳治疗顺序的数据。我们使用来自一家综合癌症中心的真实世界数据来描述应用的治疗顺序，并确定治疗相关结局和生存结局。
本历史性队列研究纳入了年龄在18岁及以上接受全身治疗的HR+HER2-ABC患者。确定了序贯治疗方案、治疗中断时间、化疗时间和总生存期（OS），并按一线治疗进行分层。
共纳入202例患者。他们总共接受了650个治疗疗程（中位数为3；范围：1-11）。分别有91例（45%）、25例（12%）、24例（12%）、28例（14%）、22例（11%）和12例（6%）患者一线治疗开始时使用非甾体类芳香化酶抑制剂（NSAI）、NSAI+细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）、氟维司群+CDK4/6i、他莫昔芬、化疗及其他治疗。一线、二线和三线分别给予了10种、13种和14种不同的治疗方案。在开始一线NSAI单药治疗的患者（n=91）中，3例（3%）在接受二线治疗前死亡。
在这个真实世界队列中，我们观察到日常临床实践中应用了多种不同的治疗顺序，其中一些与当前指南不一致。我们的研究结果不支持这样的担忧，即如果患者一开始未使用CDK4/6i，可能永远无法接受CDK4/6i治疗。
