The efficacy of first-line chemotherapy in endocrine-resistant hormone receptor-positive (HR+), human epidermal growth f
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EPIDEMIOLOGY
The efficacy of first‑line chemotherapy in endocrine‑resistant hormone receptor‑positive (HR+), human epidermal growth factor receptor 2‑negative (HER2−) metastatic breast cancer Sudpreeda Chainitikun1 · James P. Long2 · Ruben Rodriguez‑Bautista1,3 · Toshiaki Iwase1 · Debu Tripathy1 · Takeo Fujii1 · Naoto T. Ueno1 Received: 27 February 2020 / Accepted: 6 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Combinations of endocrine therapy (ET) and targeted therapy (CDK4/6 or mTOR inhibitors) are standard of care for HR+/HER2− metastatic breast cancer (MBC). When ET is not effective, chemotherapy is commonly used. However, clinical outcomes of chemotherapy in the endocrine-resistant setting are limited. The purpose of this study was to identify predictive factors and the compare efficacies of chemotherapy agents in endocrine-resistant MBC. Methods We conducted a retrospective study of patients with HR+/HER2− MBC who received chemotherapy after progression on ET with or without targeted therapy at MD Anderson Cancer Center from 1999 to 2017. We collected baseline clinicopathological and all treatment data. Primary endpoint was time to treatment failure (TTF) of first-line chemotherapy for MBC. Results For the 1258 patients analyzed, mean age was 55.3 years (range 21–91). Previous treatment with targeted therapy was recorded for 390 patients (31%): 264 with CDK4/6 inhibitor, 205 with mTOR inhibitor, and 79 treated with both. The most frequent chemotherapy agents were capecitabine (48.9%) and taxanes (28.6%). After adjustment for all factors in a multivariate model, previous treatment with a CDK4/6 inhibitor had the strongest negative effect on TTF regardless of ET duration (hazard ratio [HR] 1.84; 95%CI 1.49–2.27; p
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