First-line bevacizumab in combination with chemotherapy for HER2-negative metastatic breast cancer: pooled and subgroup analyses of data from 2447 patients
First-line bevacizumab in combination with chemotherapy for HER2-negative metastatic breast cancer: pooled and subgroup analyses of data from 2447 patients
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DOI：
10.1093/annonc/mdt276
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发表时间：
2013-11-01
影响因子：
50.5
通讯作者：
O'Shaughnessy, J.
中科院分区：
文献类型：
--
作者：
Miles, D. W.;Dieras, V.;O'Shaughnessy, J.
贝伐单抗与一线化疗联合治疗her2阴性转移性乳腺癌（mBC）时，一直显示出改善的无进展生存期（PFS）和缓解率。然而，缺乏显着的总生存期（OS）差异继续引起争论，并且确定从贝伐单抗中获益最大的患者仍然难以捉摸。我们分析了来自3个随机III期临床试验的患者数据，这些临床试验在一线her2阴性mBC环境中进行，特别关注对预后不良患者的疗效。荟萃分析（n = 2447）显示PFS风险比（HR）为0.64（95%可信区间[CI] 0.57-0.71；贝伐单抗治疗中位时间为9.2个月，非贝伐单抗治疗中位时间为6.7个月），缓解率分别为49%和32%。OS HR为0.97 (95% CI 0.86-1.08)；中位数分别为26.7个月和26.4个月。在三阴性mBC患者中，PFS和OS的hr分别为0.63 （95% CI 0.52-0.76）和0.96 （95% CI 0.79-1.16）。贝伐单抗组的中位PFS为8.1个月，单独化疗组为5.4个月，中位OS分别为18.9个月和17.5个月，1年OS率为71%和65%。贝伐单抗提高了总体和治疗选择有限的预后不良患者亚组的疗效，包括1年总生存率。
Bevacizumab has consistently demonstrated improved progression-free survival (PFS) and response rate when combined with first-line chemotherapy for HER2-negative metastatic breast cancer (mBC). However, the lack of a significant overall survival (OS) difference continues to attract debate, and identification of patients deriving greatest benefit from bevacizumab remains elusive.Individual patient data from three randomised phase III trials in the first-line HER2-negative mBC setting were analysed, focusing specifically on efficacy in poor-prognosis patients.The meta-analysis (n = 2447) demonstrated a PFS hazard ratio (HR) of 0.64 (95% confidence interval [CI] 0.57-0.71; median 9.2 months with bevacizumab versus 6.7 months with non-bevacizumab therapy) and response rate of 49% versus 32%, respectively. The OS HR was 0.97 (95% CI 0.86-1.08); median 26.7 versus 26.4 months, respectively. In patients with triple-negative mBC, the HRs for PFS and OS were 0.63 (95% CI 0.52-0.76) and 0.96 (95% CI 0.79-1.16), respectively. Median PFS was 8.1 months with bevacizumab versus 5.4 months with chemotherapy alone, median OS was 18.9 versus 17.5 months, respectively, and 1-year OS rates were 71% versus 65%.Bevacizumab improves efficacy, including 1-year OS rates, both overall and in subgroups of poor-prognosis patients with limited treatment options.