High-Dose Estrogen as Salvage Hormonal Therapy for Highly Refractory Metastatic Breast Cancer: A Retrospective Chart Review
High-Dose Estrogen as Salvage Hormonal Therapy for Highly Refractory Metastatic Breast Cancer: A Retrospective Chart Review
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DOI：
10.1016/j.clinthera.2009.11.002
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发表时间：
2009-01-01
影响因子：
3.2
通讯作者：
Vogel, Charles L.
中科院分区：
文献类型：
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作者：
Mahtani, Reshma L.;Stein, Alisha;Vogel, Charles L.
背景：对于转移性乳腺癌(MBC)患者，高密度雌激素(HDE)是一种有效但被广泛忽视的治疗选择。目的：本研究的目的是报告我们在绝经后晚期乳腺癌患者中使用HDE的经验。方法：获得当地机构审查委员会的批准，对2001年至2009年3月在佛罗里达州博卡拉顿综合癌症中心接受HDE治疗的MBC患者进行了回顾性图表回顾。结果：在426名确诊的MBC患者中，我们发现26名MBC患者在任何一种治疗方案中都服用了HDE。HDE治疗开始时的中位年龄为59岁(范围42-92岁)。经荧光原位杂交分析，26例患者中有3例(11.5%)为人表皮生长因子受体2阳性。除1名患者之前没有接受过转移性疾病的系统治疗外，所有患者在HDE开始前都接受了多种治疗(化疗和激素治疗)(中位数，7行；范围0-12)。在20例可测量的转移性疾病(内脏和/或软组织转移)患者中，有5例(25%)有客观的抗肿瘤反应，定义为部分缓解(PR)或完全缓解(CR)。另外4名患者(20%)的病情稳定时间延长了6个月。在6例无法测量的转移性疾病(仅限于骨骼)中，有3例(50%)的SD延长了6个月。所有患者的临床受益率(定义为CR+PR+SD>；=6个月)为46%(12/26)，中位持续时间为10个月。26名受试者的总体中位无进展生存期为5个月。从HDE开始的中位生存期为17个月(范围为3-54个月)。AES包括液体滞留(8[31%])、阴道出血(7[27%])和恶心(4[15%])。2例患者在1个月后停止治疗。其余24名患者中有3名因不良反应而停止雌激素治疗。结论：这份回顾图表详细介绍了我们机构在晚期乳腺癌患者中使用HDE的经验，他们中的大多数人都曾接受过多次治疗。我们的数据表明，对于接受大量治疗的患者来说，这种治疗是另一种选择，在这些患者中，进一步的内分泌操作可能仍然是合适的。(CLIN THER.2009年；31[主题问题]：2371-2378(C)2009年Excerpta Medica Inc.
Background: High-close estrogens (HDEs) are an efficacious but widely overlooked treatment option for patients with metastatic breast cancer (MBC). This is due in part to the introduction of tamoxifen in the 1970s, which was proven to be equivalent in efficacy and associated with fewer adverse events (AEs).Objective: The aim of this study was to report our experience with the use of HDE in postmenopausal women with advanced breast cancer.Methods: Local institutional review board approval was obtained to conduct a retrospective chart review of patients with MBC treated with HDEs at the Boca Raton Comprehensive Cancer Center, Boca Raton, Florida, from 2001 through March 2009. Demographic information, response rates, and tolerability profiles were collected.Results: Of the 426 patients with MBC identified, we found 26 patients with MBC who were prescribed HDEs as a treatment in any line of therapy for advanced breast cancer. The median age at the start of HDE therapy was 59 years (range, 42-92 years). Three of the 26 patients (11.5%) were human epidermal growth factor receptor 2-positive determined via fluorescent in situ hybridization analysis. With the exception of 1 patient who had received no prior systemic treatment for metastatic disease, all patients received multiple lines of treatment (both chemotherapy and hormonal treatments) in the advanced setting (median, 7 lines; range, 0-12) prior to the initiation of HDE. Five of 20 patients (25%) with measurable metastatic disease (visceral and/or soft tissue metastases) had objective antitumor responses defined as either a partial response (PR) or a complete response (CR). Four additional patients (20%) had prolonged stable disease (SD) for >= 6 months. Three of 6 patients (50%) with nonmeasurable metastatic disease (bone-only) had prolonged SD for >= 6 months. Clinical benefit rate (defined as CR + PR + SD >= 6 months) for all patients was 46% (12/26), with a median duration of 10 months. Overall median progression-free survival for the 26 Subjects was 5 months. Median survival from the start of HDE was 17 months (range, 3-54 months). AEs included fluid retention (8 [31%]), vaginal bleeding (7 [27%]), and nausea (4 [15%]). Two patients discontinued therapy after 1 month. Three of the remaining 24 patients discontinued estrogen therapy due to AEs.Conclusions: This retrospective chart review details Our facility's experience with the use of HDE in patients with advanced breast cancer, most of whom had received multiple prior treatments. Our data Suggest that this treatment is another option for heavily-treated patients in whom further endocrine manipulation might still be appropriate. (Clin Ther. 2009;31 [Theme Issue]:2371-2378 (C) 2009 Excerpta Medica Inc.