转移性乳腺癌治疗领域已经有了很大进步。然而，找到治疗三阴性（激素受体阴性，ER/PR及HER-2）乳腺癌的最优细胞毒药物仍然是一个挑战。
在ASCO乳腺癌论坛上展出的一项试验对四种细胞毒药物治疗转移性三阴性乳腺癌的效果进行对比研究。
方法
该研究回顾了美国19个社区肿瘤学诊所共225位三阴性乳腺癌患者分别经艾日布林(E=47)，希罗达(C=69)，吉西他滨（G=56）及长春瑞滨(V=53)单独治疗的疗效。数据收集包括基线患者特点，体力状态，当前治疗的持续期，生长因子的使用及全剂量限制性毒性。治疗失败时间（TTF）从化疗第一个周期开始测定，直到疾病进展或由毒性、死亡引起的停药终止。然后通过Kaplan-Meier方法及调整到临床环境的COX比例风险模型来估计TTF值。为了控制观察研究中固有的选择偏差，采用倾向评分加权TTF分析。
结果
患者化疗前在年龄，体力状态，无病生存期，并存病及血红蛋白水平方面相似。经各药物治疗的中位阶段分别为，经希罗达治疗的患者为中位二线治疗，吉西他滨为中位3线治疗，长春瑞滨为中位3线治疗，艾日布林为中位4线治疗。希罗达，吉西他滨，艾日布林的中位治疗期将近两个月，而长春瑞滨为1.6个月。使用艾日布林作为参照，调整治疗线，并关联预后因子，倾向评分加权Cox 回归分析没有发现TTF有显著差异：希罗达vs艾日布林：HR= 1.15 (0.75 to 1.76)，吉西他滨vs艾日布林：HR = 0.62 (0.34 to 1.13)，长春瑞滨vs艾日布林：HR = 1.0 (0.60 to 1.37)。
结论
该研究发现，对于转移性三阴性乳腺癌患者，与其它药物相比，艾日布林用于更晚的治疗。然而，即使是用于更晚的治疗时，艾日布林也可产生至少相当的药物活性。这些发现可对大量人群进行生物异质性评价的进一步分析提供依据。
原文阅读：
Background: There has been considerable progress in treatments for MBC. However, the identification of optimal cytotoxic agents in patients with triple negative disease (negative for hormone receptors, ER/PR and HER-2) remains a therapeutic challenge. A comparative effectiveness analysis of four cytotoxic agents was conducted in patients with TN MBC.
Methods: We retrospectively identified 225 patients treated with single agent eribulin (E=47), capecitabine (C=69), gemcitabine (G=56) or vinorelbine (V=53) in 19 community oncology clinics across the US. Data collection included baseline patient characteristics, performance status, duration of current therapy, growth factor use and all dose limiting toxicities. Time to treatment failure (TTF) was measured from the first cycle of chemotherapy until disease progression, discontinuation due to toxicity, or death. TTF was then estimated using the Kaplan-Meier method and Cox proportional hazard modeling adjusted for clustering on the practice site. To control for selection bias that is inherent in observational studies, a propensity score weighted TTF analysis was also conducted.
Results: Patients were comparable with respect to age, performance status, duration of disease free survival, presence of comorbidities and hemoglobin level prior to the start of chemotherapy. However, the median lines of therapy for use of C, G, V and E were 2nd, 3rd, 3rd, and 4th, respectively. The median duration of treatment was approximately 2 months with C, G, and E compared to 1.6 months with V. Using eribulin as the reference and adjusting for line of therapy and associated prognostic factors, the propensity score weighted Cox regression analysis did not identify statistically significant differences in TTF: C vs. E: HR = 1.15 (0.75 to 1.76), G vs. E: HR = 0.62 (0.34 to 1.13), V vs. E: HR = 1.0 (0.60 to 1.37).
Conclusions: In patients with TN-MBC treated in a community oncology setting, eribulin was utilized in later lines than other agents. However, eribulin demonstrated at least comparable drug activity even when used in more heavily pretreated patients. These findings warrant further analyses in a larger population with an evaluation of biologic heterogeneity.
编译自：ASCO abstract search, 2014 Breast Cancer Symposium,Temp Abst ID 136486
