Impact of chemotherapy regimens prior to endocrine therapy - Results from the ATAC (anastrozole and tamoxifen, alone or in combination) trial
Impact of chemotherapy regimens prior to endocrine therapy - Results from the ATAC (anastrozole and tamoxifen, alone or in combination) trial
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DOI：
10.1002/cncr.22042
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发表时间：
2006-08-01
期刊：
影响因子：
6.2
通讯作者：
Cuzick, Jack
中科院分区：
文献类型：
--
作者：
Buzdar, Aman U.;Guastalla, Jean-Paul;Cuzick, Jack
背景。 ATAC（阿那曲唑和他莫昔芬，单独或联合）试验的 33 个月中位随访显示阿那曲唑和既往化疗之间存在潜在的相互作用；然而，在 47 个月的中位随访中，这一数字要小得多。当时评估不同化疗方案的效果时，明显的相互作用仅限于接受环磷酰胺、甲氨蝶呤和5-氟尿嘧啶（CMF）治疗的患者。 方法。在这项对 68 个月数据的回顾性分析中，我们研究了既往化疗（包括不同化疗方案）对复发时间的影响。化疗方案为 1) 仅 CMF； 2）含蒽环类药物的方案（蒽环类药物或蒽环类药物和CMF）； 3) 其他化疗方案，包括含紫杉烷的组合。 结果。没有发现既往化疗和阿那曲唑之间存在相互作用的证据（既往接受或未接受化疗的患者的风险比 [HR] 分别为 0.89 与 0.74；相互作用的 P = .21）。对于既往接受化疗的患者，与他莫昔芬相比，阿那曲唑的 HR 从中位随访 47 个月时的 0.98（95% CI，0.76-1.28）变为中位随访 68 个月时的 0.89（95% CI，0.71-1.12），更接近总体治疗效果（HR，0.79；95% CI， 0.70-0.90）。根据化疗类型没有发现差异，并且对于既往接受 CMF 的患者来说，阿那曲唑的益处现在也很明显（HR，0.89；95% CI，0.63-1.24）。结论。根据 5 年完整治疗分析，ATAC 试验并未表明阿那曲唑的相对治疗益处在接受过化疗的患者和未接受过化疗的患者之间存在显着差异。
BACKGROUND. The 33-month median follow-up of the ATAC (anastrozole and tamoxifen, alone or in combination) trial showed a potential interaction between anastrozole and previous chemotherapy; however, this was much smaller at 47 months' median follow-up. When the effects of different chemotherapy regimens were evaluated at that time, the apparent interaction was limited to patients who had received cyclophosphamide, methotrexate, and 5-fluorouracil (CMF).METHODS. in this retrospective analysis of 68-month data, we investigated the impact of prior chemotherapy, including different chemotherapy regimens, on time to recurrence. The chemotherapy regimens were 1) CMF only; 2) anthracycline-containing regimens (anthracycline or anthracycline and CMF); and 3) other chemotherapy regimens, including taxane-containing combinations.RESULTS. No evidence was found for an interaction between prior chemotherapy and anastrozole (hazard ratio [HR] 0.89 vs. 0.74 for those with or without prior chemotherapy, respectively; P = .21 for interaction). For those with prior chemotherapy, the HR of anastrozole when compared with that of tamoxifen shifted from 0.98 (95% confidence intervals [CI], 0.76-1.28) at 47 months' median follow-up to 0.89 (95% CI, 0.71-1.12) at 68 months' median follow-up and was closer to the overall treatment effect (HR, 0.79; 95% CI, 0.70-0.90). No differences according to type of chemotherapy were seen, and a benefit for anastrozole was also now apparent for patients receiving prior CMF (HR, 0.89; 95% CI, 0.63-1.24).CONCLUSIONS. On the basis of the 5-year Completed Treatment Analysis, the ATAC trial does not indicate that the relative treatment benefits of anastrozole differ significantly between patients who received prior chemotherapy and those who did not.