Abstract：
BACKGROUND: Taxanes are one of the most effective chemotherapies (CT) in breast cancer (BC), but the efficacy of taxanes rechallenge in early metastatic relapse has been poorly studied in patients previously treated by taxanes in the (neo)adjuvant setting. Our study aimed to analyse the efficacy of taxane rechallenge in case of early metastatic relapse in a multicentre retrospective observational study compared with other chemotherapies.
METHODS: We analysed the French national ESME metastatic BC (MBC) database and selected HER2- MBC patients who received CT in first-line treatment for a metastatic relapse occurring 3-24 months after previous (neo)adjuvant taxanes treatment.
RESULTS: Of 23,501 female patients with MBC in ESME, 1057 met the selection criteria. 58.4% received a taxane-based regimen (75.4% concomitant bevacizumab) and 41.6% received other CT. In hormone-receptor positive (HR+)/HER2- MBC, multivariate analysis showed no difference in OS between taxanes without bevacizumab compared to other CT (HZR = 1.3 [0.97; 1.74], but taxanes was significantly associated with worse PFS (HZR = 1.48 [1.14; 1.93]). In TNBC, taxanes without bevacizumab and carboplatin/gemcitabine were not superior to other CT for OS (HZR = 1.07 [0.79; 1.44] and HZR = 0.81 [0.58; 1.13], respectively), while for PFS, taxanes was inferior (HZR = 1.33 [1.06-1.67]) and carboplatin plus gemcitabine was superior to other CT (HZR = 0.63 [0.46; 0.87]). For both subtypes, the worse outcome observed with paclitaxel was no longer observed with the addition of bevacizumab.
CONCLUSIONS: With the limitation of retrospective design, taxanes rechallenge in early metastatic relapse of BC may result in a worse PFS in TNBC and HR+/HER2- MBC, which was not observed with the addition of bevacizumab.
METHODS: We analysed the French national ESME metastatic BC (MBC) database and selected HER2- MBC patients who received CT in first-line treatment for a metastatic relapse occurring 3-24 months after previous (neo)adjuvant taxanes treatment.
RESULTS: Of 23,501 female patients with MBC in ESME, 1057 met the selection criteria. 58.4% received a taxane-based regimen (75.4% concomitant bevacizumab) and 41.6% received other CT. In hormone-receptor positive (HR+)/HER2- MBC, multivariate analysis showed no difference in OS between taxanes without bevacizumab compared to other CT (HZR = 1.3 [0.97; 1.74], but taxanes was significantly associated with worse PFS (HZR = 1.48 [1.14; 1.93]). In TNBC, taxanes without bevacizumab and carboplatin/gemcitabine were not superior to other CT for OS (HZR = 1.07 [0.79; 1.44] and HZR = 0.81 [0.58; 1.13], respectively), while for PFS, taxanes was inferior (HZR = 1.33 [1.06-1.67]) and carboplatin plus gemcitabine was superior to other CT (HZR = 0.63 [0.46; 0.87]). For both subtypes, the worse outcome observed with paclitaxel was no longer observed with the addition of bevacizumab.
CONCLUSIONS: With the limitation of retrospective design, taxanes rechallenge in early metastatic relapse of BC may result in a worse PFS in TNBC and HR+/HER2- MBC, which was not observed with the addition of bevacizumab.
摘要：
背景：紫杉烷是乳腺癌（BC）最有效的化疗（CT）之一，但是紫杉烷类再激发在早期转移性复发中的疗效在以前接受紫杉烷类（neo）辅助治疗的患者中研究甚少。我们的研究旨在分析紫杉烷再激发在多中心回顾性观察研究中与其他化学疗法相比，在早期转移性复发的情况下的疗效。
方法：我们分析了法国国家ESME转移性BC（MBC）数据库，并选择了HER2-MBC患者，这些患者在一线治疗中接受了CT治疗，在先前（新）辅助紫杉烷治疗后3-24个月发生转移性复发。
结果：在23,501例ESME患者中，1057符合选择标准。58.4%接受了基于紫杉烷的方案(75.4%合并贝伐单抗)，41.6%接受了其他CT。在激素受体阳性（HR+）/HER2-MBC中，多变量分析显示，与其他CT相比，没有贝伐单抗的紫杉烷类之间的OS没有差异（HZR=1.3[0.97;1.74]，但紫杉烷与较差的PFS显著相关(HZR=1.48[1.14;1.93])。在TNBC,没有贝伐单抗和卡铂/吉西他滨的紫杉烷类药物在OS方面不优于其他CT（HZR=1.07[0.79;1.44]和HZR=0.81[0.58;1.13]，分别)，而对于PFS，紫杉烷类次品(HZR=1.33[1.06-1.67]),卡铂+吉西他滨优于其他CT(HZR=0.63[0.46;0.87]).对于这两个子类型，在添加贝伐单抗的情况下,不再观察到紫杉醇的不良结局.
结论：由于回顾性设计的局限性，紫杉烷类药物在早期转移性BC复发中的再攻击可能导致TNBC和HR/HER2-MBC的PFS恶化，这在添加贝伐单抗时未观察到。
方法：我们分析了法国国家ESME转移性BC（MBC）数据库，并选择了HER2-MBC患者，这些患者在一线治疗中接受了CT治疗，在先前（新）辅助紫杉烷治疗后3-24个月发生转移性复发。
结果：在23,501例ESME患者中，1057符合选择标准。58.4%接受了基于紫杉烷的方案(75.4%合并贝伐单抗)，41.6%接受了其他CT。在激素受体阳性（HR+）/HER2-MBC中，多变量分析显示，与其他CT相比，没有贝伐单抗的紫杉烷类之间的OS没有差异（HZR=1.3[0.97;1.74]，但紫杉烷与较差的PFS显著相关(HZR=1.48[1.14;1.93])。在TNBC,没有贝伐单抗和卡铂/吉西他滨的紫杉烷类药物在OS方面不优于其他CT（HZR=1.07[0.79;1.44]和HZR=0.81[0.58;1.13]，分别)，而对于PFS，紫杉烷类次品(HZR=1.33[1.06-1.67]),卡铂+吉西他滨优于其他CT(HZR=0.63[0.46;0.87]).对于这两个子类型，在添加贝伐单抗的情况下,不再观察到紫杉醇的不良结局.
结论：由于回顾性设计的局限性，紫杉烷类药物在早期转移性BC复发中的再攻击可能导致TNBC和HR/HER2-MBC的PFS恶化，这在添加贝伐单抗时未观察到。
