Predictors of Aromatase Inhibitor Discontinuation as a Result of Treatment-Emergent Symptoms in Early-Stage Breast Cancer
Predictors of Aromatase Inhibitor Discontinuation as a Result of Treatment-Emergent Symptoms in Early-Stage Breast Cancer
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DOI：
10.1200/jco.2011.38.0261
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发表时间：
2012-03-20
影响因子：
45.3
通讯作者：
Storniolo, Anna Maria
中科院分区：
文献类型：
--
作者：
Henry, N. Lynn;Azzouz, Faouzi;Storniolo, Anna Maria
芳香化酶抑制剂（AIs）对激素受体阳性乳腺癌的治疗是有效的，但治疗的依从性和持久性较差。治疗中止的预测因素尚未明确定义。这是未知的患者是否无法忍受的毒性从一个AI能够容忍another.Patients and MethodsWomen与早期乳腺癌启动AI治疗入组到一个多中心的，前瞻性的，开放标签的随机试验，阿伐美坦与来曲唑。患者在基线和治疗期间连续完成症状问卷。开发AI相关的不可忍受的症状和停止治疗的患者被给予的选择切换到其他研究AI后2至8周washoutperiod.ResultsOf的503名妇女，32.4%的初始AI治疗在2年内，因为不良反应，24.3%，特别是因为肌肉骨骼症状。至因任何症状而停药的中位时间为6.1个月（范围为0.1至21.2个月），随机分配至依西美坦组的患者明显更短（风险比[HR]，1.5; 95% CI，1.1至2.1; P = 0.02）。年龄较小和紫杉烷类化疗与治疗中止的可能性较高相关（HR，1.4; 95% CI，1.02 - 1.9; P = 0.04; HR，1.9; 95% CI，1.00 - 3.6; P = 0.048）。选择切换到第二个AI的83例患者中，38.6%继续交替AI的中位数为13.7 months.ConclusionPremature中止初始AI治疗的症状是常见的，虽然超过三分之一的患者可能能够耐受不同的AI药物。需要进行更多的研究来确定AI相关治疗后出现的症状的预测工具和干预措施。J Clin Oncol 30：936-942. (C)2012年美国临床肿瘤学会
PurposeAromatase inhibitors (AIs) are effective for treatment of hormone receptor-positive breast cancer, but adherence and persistence with therapy are poor. Predictors of treatment discontinuation are not clearly defined. It is unknown whether patients with intolerable toxicity from one AI are able to tolerate another.Patients and MethodsWomen with early-stage breast cancer initiating AI therapy were enrolled onto a multicenter, prospective, open-label randomized trial of exemestane versus letrozole. Patients completed symptom questionnaires at baseline and serially during therapy. Patients who developed AI-associated intolerable symptoms and discontinued treatment were given the option to switch to the other study AI after a 2- to 8-week washout period.ResultsOf the 503 enrolled women, 32.4% discontinued initial AI therapy within 2 years because of adverse effects; 24.3% discontinued specifically because of musculoskeletal symptoms. Median time to treatment discontinuation as a result of any symptom was 6.1 months (range, 0.1 to 21.2 months) and was significantly shorter in patients randomly assigned to exemestane (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = .02). Younger age and taxane-based chemotherapy were associated with higher likelihood of treatment discontinuation (HR, 1.4; 95% CI, 1.02 to 1.9; P = .04; and HR, 1.9; 95% CI, 1.00 to 3.6; P = .048, respectively). Of the 83 patients who chose to switch to the second AI, 38.6% continued the alternate AI for a median of 13.7 months.ConclusionPremature discontinuation of initial AI therapy as a result of symptoms is common, although more than one third of patients may be able to tolerate a different AI medication. Additional research is needed to identify predictive tools and interventions for AI-associated treatment-emergent symptoms. J Clin Oncol 30: 936-942. (C) 2012 by American Society of Clinical Oncology