依维莫司治疗内分泌耐药型激素受体阳性晚期乳腺癌的疗效与安全性分析

Effectiveness and safety of everolimus in treatment of endocrine-resistant hormone receptorpositive advanced breast cancer

  • 摘要: 目的 探索依维莫司(everolimus,EVE)联合其他内分泌药对内分泌耐药型激素受体(hormone receptor,HR)阳性转移性乳腺癌患者的疗效和安全性。 方法 回顾性分析解放军总医院2012年2月1日-2015年6月1日24例内分泌耐药型HR阳性晚期乳腺癌患者接受依维莫司联合他莫西芬(tamoxifen,TAM)、芳香化酶抑制剂(aromatase inhibits,AIs)或氟维司群(fulvestrant,FUL)治疗的疗效和不良反应。 结果 随访10个月,至治疗失败中位时间(median time to treatment failure,mTTF)为 4.0 个月 (95% CI:2.2~5.8),中位总生存时间 (median overall survival,mOS)为 15.8 个月 (95% CI:9.0~22.7)。客观缓解率(objective response rate,ORR)为20.9%,疾病控制率(disease control rate,DCR)为62.5%。根据联合用药不同,EVE联合TAM、AIs及FUL的中位TTF分别为2.0个月、4.0个月、5.5个月(P=0.731),中位OS分别为9.6个月、15.8个月、11.4个月(P=0.829)。单因素分析显示:雌激素受体(estrogen receptor,ER)/孕激素受体(progesterone receptor,PR)状态与AIs耐药是TTF的影响因素,PR状态和组织学分级是OS的影响因素,口腔炎的发生与TTF、OS均显著相关。EVE疗效及患者预后与既往解救治疗线数无相关性。Cox多因素回归分析显示:AIs耐药及口腔炎是TTF的独立预后因素(P均为0.001)。最常见的不良反应为口腔炎(83.33%)、疲劳(37.50%)、非感染性肺病(25.00%)、感染(33.33%)、皮疹(16.70%)、高血糖(12.50%)、恶心呕吐(39.17%)、腹泻(25.00%)、咳嗽(50.00%)。最常见的Ⅲ/Ⅳ级不良事件为非感染性肺病(16.67%)、口腔炎(4.17%)和感染(4.17%)。 结论 依维莫司联合其他内分泌药物对内分泌耐药型HR阳性晚期乳腺癌疗效确切,可延缓内分泌耐药导致的疾病进展。依维莫司耐受良好。

     

    Abstract: Objective To explore the effectiveness and safety of everolimus (EVE) combined with other endocrine drugs on endocrine-resistant hormone receptor-positive (HR-positive) metastatic breast cancer patients. Methods The curative effect and adverse reactions of 24 endocrine-resistant HR-positive advanced breast cancer patients who received everolimus combined with tamoxifen (TAM), aromatase inhibitors (AIs) or fulvestrant (Ful) in Chinese PLA General Hospital from February 1, 2012 to June 1, 2015 were retrospectively analyzed. Results After 10 months of follow-up, the median time to treatment failure (mTTF) was 4(95%CI, 2.2 to 5.8) months, and the median overall survival (mOS) was 15.8 months (95%CI, 9.0 to 22.7). The objective response rate (ORR) was 20.9%, and the disease control rate (DCR) was 62.5%. EVE combined with TAM, AIs, and Ful had a median TTF of 2 months, 4 months, and 5.5 months, respectively (P=0.731), and the median OS was 9.6 months, 15.8 months, 11.4 months respectively (P=0.829). Univariate analysis showed that estrogen receptor (ER)/progesterone receptor (PR) status and AIs resistance were the factors affecting TTF and PR, and histological grade was the factor that affecting the OS. The occurrence of stomatitis was significantly correlated with TTF and OS. There was no correlation between EVE's curative effect, patients' prognosis and the number of previously rescued treatment lines. Cox regression analysis showed that AIs resistance (HR, 0.082; 95%CI, 0.019 to 0.353) and stomatitis (HR, 0.148; 95%CI, 0.050 to 0.435) were independent prognostic factors of TTF. The most common adverse reactions were stomatitis (83.33%), fatigue (37.50%), non-infectious lung disease (25.00%), infection (33.33%), skin rash (16.70%)and hyperglycemia (12.50%), nausea and vomiting (39.17%), diarrhea (25.00%), cough (50.00%). The most common Ⅲ /Ⅳ adverse events were non-infectious lung disease (16.67%), stomatitis (4.17%) and infection (4.17%). Conclusion Everolimus combined with other endocrine drugs is definitely effective on endocrine-resistant HR-positive advanced breast cancer. Everolimus can prolong the progression of endocrine-resistant diseases, and it is well tolerated.

     

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