Agostini Margherita, Mandrioli Anna, Zamagni Claudio
Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy.
Cancers (Basel). 2024 Dec 15;16(24):4179. doi: 10.3390/cancers16244179.
The treatment of hormone receptor positive (HR+), HER-2 negative metastatic breast cancer (MBC) has radically changed over the last few years. CDK4/6 inhibitors combined with endocrine therapy have become the standard of care as a front-line therapeutic approach, conferring a significant improvement in progression-free survival and overall survival compared to traditional endocrine therapy (ET) alone. However, the wide administration of these drugs in clinical practice paved the way for the emergence of new intrinsic and acquired mechanisms of resistance that seem to compromise second-line treatment effectiveness. In this context, fulvestrant monotherapy appears disqualified. we evaluated a population of 30 women currently treated in our oncology unit with HR+/HER2- metastatic breast cancer, receiving fulvestrant 500 mg every 28 days after progression to first-line therapy with CDK 4/6 inhibitors combined with aromatase inhibitors. Of 30 patients observed, 23 progressed to fulvestrant with a median PFS of 3.7 months (range 1-9.7 months). our real-life experience suggests that second-line fulvestrant monotherapy confers very poor disease control and is quite an inadequate therapeutic option. CDK4/6i administration beyond progression could possibly be considered as more valid option, in the absence of targetable mutations or newer, more effective drugs.
在过去几年中，激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER-2阴性）转移性乳腺癌（MBC）的治疗发生了根本性变化。细胞周期蛋白依赖性激酶4/6（CDK4/6）抑制剂联合内分泌治疗已成为一线治疗方法的标准治疗方案，与单纯传统内分泌治疗（ET）相比，无进展生存期和总生存期有显著改善。然而这些药物在临床实践中的广泛应用为新的内在和获得性耐药机制的出现铺平了道路，这些机制似乎会影响二线治疗的效果。在这种情况下，氟维司群单药治疗似乎不合格。我们评估了30名目前在我们肿瘤科室接受HR+/HER2-转移性乳腺癌治疗的女性患者群体，她们在一线接受CDK4/6抑制剂联合芳香化酶抑制剂治疗进展后，每28天接受500mg氟维司群治疗。在观察的30例患者中，23例对氟维司群治疗进展，中位无进展生存期为3.7个月（范围1-9.7个月）。我们的实际经验表明，二线氟维司群单药治疗对疾病的控制非常差，是一种相当不足的治疗选择。在没有可靶向突变或更新、更有效药物的情况下，疾病进展后继续使用CDK4/6抑制剂可能被认为是更有效的选择。
