Hormonaltherapymightbeabetterchoiceasmaintenancetreatmentthancapecitabineafterresponsetofirst-linecapecitabine-basedcombinationchemotherapyforpatientswithhormonereceptor-positiveandHER2-negative,metastaticbreastcancer

摘要： Background:Bothhormonaltherapy(HT)andmaintenancecapecitabinemonotherapy(MCT)havebeenshowntoextendtimetoprogression(TTP)inpatientswithmetastaticbreastcancer(MBC)afterfailureoftaxanesandanthracycline?containingregimens.However,noclinicaltrialshavedirectlycomparedtheefficacyofMCTandHTafterresponsetofirst?linecapecitabine?basedcombinationchemotherapy(FCCT)inpatientswithhormonereceptor(HR)?positiveandhumanepidermalgrowthfactorreceptor2(HER2)?negativebreastcancer.Methods:Weretrospectivelyanalyzedthechartsof138HR?positiveandHER2?negativeMBCpatientswhowereinnon?progressionstatusafterFCCTandwhoweretreatedbetween2003and2012attheCancerInstituteandHospital,ChineseAcademyofMedicalSciences,inBeijing,China.Themediannumberoffirst?linechemotherapycycleswas6(range,4–8);combinedagentsincludedtaxanes,vinorelbine,orgemcitabine.Ofthese138patients,79receivedMCT,and59receivedHT.Single?agentcapecitabinewasadministeredatadoseof1250mg/m2twicedailyfor14days,followedbya7?dayrestperiod,repeatedevery3weeks.Ofthe59patientswhoreceivedHT,37receivedaromataseinhibitors(AIs),8receivedselectiveestrogenreceptormodulators(SERMs),and14receivedgoserelinpluseitherAIsorSERMs.WethencomparedtheMCTgroupandHTgroupintermsoftreatmentefficacy.Results:Withamedianfollow?upof43months,patientsintheHTgrouphadamuchlongerTTPthanpatientsintheMCTgroup(13vs.8months,Pease?freesurviv=0.011).WhenTTPwasadjustedforage,menopausalstatus,Karnofskyperformancestatusscore,disal,siteofmetastasis,numberofmetastaticsites,andresponsestatusafterFCCT,extendedTTPwasstillobservedforpatientsintheHTgroup(hazardratio:0.63;95%confidenceinterval:0.44–0.93;P=0.020).WealsoobservedatrendofoverallsurvivaladvantageforpatientsintheHTgroupvs.patientsintheMCTgroup,butthedifferencewasnotsignificant(43vs.37months,PtientsintheMCTg=0.400).Inaddition,patientsintheHTgroupgen?erallytoleratedthetreatmentwell,whereasparoupexperiencedgrades3–4adverseevents,themostfrequentofwhichwerehand?footsyndrome(15.8%)andhematologicabnormalities(7.6%).Conclusion:ForHR?positiveandHER2?negativeMBCpatients,HTmightbeconsideredatreatmentafterresponsetoFCCTbutpriortoMCTasalong?termadministration. ... （共7頁）