三阴性乳腺癌肝转移：卡培他滨 vs 铂类
对于三阴性乳腺癌，铂类是重要的化疗药物，可显著提高患者生存获益。对于乳腺癌肝转移，经过肝脏和肿瘤组织三步酶链反应转化为高效化疗药物的卡培他滨具有重要的潜在价值。不过，对于三阴性乳腺癌肝转移，卡培他滨与铂类之间缺乏头对头的随机对照研究。
2021年1月，转化医学会旗下《转化医学年鉴》正式发表中国医学科学院肿瘤医院徐兵河、樊英、陈怡萌、王佳玉、马飞、罗扬、陈闪闪、张频、李青、蔡锐刚、李俏、莫红楠、首都医科大学附属北京朝阳医院关印、北京市朝阳区三环肿瘤医院蔡锐刚、中国人民解放军总医院赵卫红等学者的真实世界研究报告，首次比较了卡培他滨或铂类化疗方案对于中国三阴性乳腺癌肝转移蒽环类、紫杉类化疗失败患者的有效性和安全性。
该多中心小样本回顾研究对2010年1月～2019年12月中国医学科学院肿瘤医院、北京朝阳医院、三环肿瘤医院、解放军总医院蒽环类、紫杉类化疗失败的三阴性乳腺癌肝转移患者进行回顾分析，其中33例给予铂类化疗方案、26例给予卡培他滨化疗方案，铂类化疗以多西他赛＋顺铂为主，卡培他滨化疗方案以紫杉醇＋卡培他滨为主。两组患者年龄、绝经状态、肿瘤大小、淋巴结分期、组织学分级、增殖指数Ki67、无病间期、转移器官数量、既往蒽环类或紫杉类化疗方案基本相似。比较指标包括客观缓解率、总生存、治疗方式、毒性反应。
结果，卡培他滨化疗方案与铂类化疗方案相比：
客观缓解率：57.7%比30.3%（P=0.035）
中位总生存：19.2个月比14.4个月（P=0.041）
通过多因素比例风险回归模型，对复发时年龄、肿瘤大小、淋巴结转移数量、组织学分级、转移器官数量、一线化疗蒽环类或紫杉类等其他影响因素进行校正后，卡培他滨化疗方案与铂类化疗方案相比，总死亡率低49%（比值比：0.51，95%置信区间，0.27～0.98，P=0.042）。
卡培他滨化疗方案与铂类化疗方案相比，疲劳、肝功能异常等治疗相关不良事件发生率相似，除了恶心、手足综合征、1～2级白细胞减少和中性粒细胞减少发生率较高。
因此，该多中心小样本回顾研究结果表明，对于三阴性乳腺癌肝转移患者，卡培他滨化疗方案与铂类化疗方案相比，客观缓解率和总生存比例显著较高，故有必要进一步开展多中心大样本前瞻随机对照研究进行验证。
Ann Transl Med. 2021 Jan;9(2):109.
Comparison of capecitabine-based regimens with platinum-based regimens in Chinese triple-negative breast cancer patients with liver metastasis.
Chen Y, Guan Y, Wang J, Ma F, Luo Y, Chen S, Zhang P, Li Q, Cai R, Li Q, Mo H, Fan Y, Zhao W, Xu B.
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Beijing Chao-Yang Hospital, Beijing, China; Beijing Sanhuan Cancer Hospital, Beijing, China; Chinese PLA General Hospital, Beijing, China.
BACKGROUND: Capecitabine-based chemotherapy (CBC) presents potential value in patients with liver metastasis; platinum-based chemotherapy (PBC) has shown promising benefit in patients with triple-negative breast cancer (TNBC). For TNBC patients with liver metastasis, which treatment strategy is better remains to be further studied. The aim of this study was to report the first real-world data evaluating the efficacy and safety of PBC versus CBC in the first-line treatment in Chinese TNBC patients with liver metastasis.
METHODS: TNBC patients with liver metastasis pretreated with anthracyclines/taxanes in 4 institutions of China between January 2010 and December 2019 were included. Objective response rate (ORR), overall survival, treatment pattern, and toxicity profile were assessed between PBC and CBC groups.
RESULTS: A total of 59 TNBC patients with liver metastasis were identified. Among these, 33 were treated with PBC and 26 were treated with CBC. The ORR was higher in the CBC group than in the PBC group (57.7% versus 30.3%, P=0.035). Median overall survival was also greatly improved (19.2 versus 14.4 months, P=0.041). Docetaxel/cisplatin was more likely to be used for PBC, and paclitaxel/capecitabine was the main regimen for CBC. Multivariable Cox regression analysis indicated that CBC was an independent predictor for overall survival after adjustment for baseline factors including age, tumor size, nodal status, prior anthracyclines/taxanes use, and tumor grade (odds ratio =0.51; 95% confidence interval, 0.27-0.98; P=0.042). Adverse events were not different except gastrointestinal tract toxicities, hand-foot syndrome and hematologic toxicity.
CONCLUSIONS: For TNBC patients with liver metastasis, capecitabin-based chemotherapy might be more suitable than the platinum-based regimen in the first-line treatment, as measured by objective response rate and overall survival. Further large-scale studies are warranted.
KEYWORDS: Capecitabine; liver metastasis; platinum; triple-negative breast cancer (TNBC)
PMID: 33569411
PMCID: PMC7867954
DOI: 10.21037/atm-20-4590
