在现实世界中,激素受体阳性、HER2 阴性转移性乳腺癌患者接受 1 线 CDK4/6 抑制剂和内分泌疗法治疗的差异。

IF 7.4 1区 医学 Q1 Medicine
Asal Pilehvari, Gretchen Kimmick, Wen You, Gloribel Bonilla, Roger Anderson
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引用次数: 0

摘要

研究目的本研究利用真实世界的观察数据,比较了接受不同一线治疗的激素受体阳性(ER+)、HER2阴性转移性乳腺癌(MBC)患者的情况:CDK4/6抑制剂(CDK4/6i)联合内分泌治疗(ET)与单独使用ET:从全国范围内的电子健康记录衍生的Flatiron Health去标识数据库(包括280家美国癌症诊所)中,我们确定了在2015年2月至2021年11月期间接受单用ET或CDK4/6i联合ET一线治疗的激素受体阳性、HER2阴性的转移性乳腺癌患者。患者的社会人口学状况、MBC 治疗方案和疗效是本次分析的重点。采用t检验和卡方检验对患者特征进行比较。进行了逻辑回归分析,以研究患者特征与接受一线 CDK4/6i 加 ET 与单用 ET 的可能性之间的关联。卡普兰-梅耶法(Kaplan-Meier method)和考克斯比例危险法(Cox proportional hazards)用于检验一线治疗方案对实际无进展生存期(PFS)和总生存期(OS)的影响。采用反概率加权法(IPW)平衡基线特征:研究对象包括3917名接受CDK4/6i加ET(n=2170)和单用ET(n=1747)治疗的MBC患者。与接受单纯 ET 治疗的患者相比,接受 CDK4/6i 加 ET 治疗的患者更年轻(平均年龄为 66.8 岁 vs. 68.6 岁,P 结论:CDK4/6i 加 ET 治疗患者的年龄与单纯 ET 治疗患者的年龄存在差异:在这个真实世界数据库中,接受一线 CDK4/6 抑制剂治疗的患者在年龄、诊断阶段、基线表现状态、合并症和保险状况方面存在差异。在调整后的分析中,使用第一线 CDK4/6i 加 ET 的 PFS 和 OS 率均优于单独使用 ET。我们有必要进一步努力,促进这一重要药物类别的公平使用和获取。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Disparities in receipt of 1-st line CDK4/6 inhibitors with endocrine therapy for treatment of hormone receptor positive, HER2 negative metastatic breast cancer in the real-world setting.

Objective: This study used real-world observational data to compare profiles of patients receiving different first-line treatment for hormone receptor positive (ER+), HER2 negative, metastatic breast cancer (MBC): CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) versus ET alone.

Method: From a nationwide electronic health record-derived Flatiron Health de-identified database including 280 US cancer clinics, we identified patients with hormone receptor positive, HER2 negative, metastatic breast cancer receiving 1st -line therapy with ET alone or CDK4/6i plus ET between February 2015 and November 2021. Patient sociodemographic status, MBC treatment regimen and outcomes were the focus of this analysis. Patient characteristics were compared using t-tests and chi-square tests. Logistic regression analysis was performed to examine the association of patient characteristics with the likelihood of receiving 1st -line CDK4/6i plus ET vs. ET alone. Kaplan-Meier method and Cox proportional hazards were used to test the impact of 1st -line treatment regimen on real-world progression-free survival (PFS) and overall survival (OS). Baseline characteristics were balanced using inverse probability weighting (IPW).

Results: The study population included 3,917 patients receiving CDK4/6i plus ET (n = 2170) and ET alone (n = 1747) for their MBC. Compared to patients receiving ET alone, those receiving CDK4/6i plus ET were younger (mean age 66.8 vs. 68.6, p < 0.001), more likely to present with de novo MBC (p < 0.001), had better performance status (50.2% vs. 40.5% patients with ECOG value 0, p = 0.001) and lower number of comorbidities (29.7% vs. 26.6% ≥ 1 comorbidity, p < 0.001). Logistic regression revealed increased odds of CDK4/6i plus ET in individuals aged 50-64 (OR: 3.42, 95% CI [2.41, 4.86]) and 65-74 (OR: 3.18, 95% CI [1.68, 6.02]) versus those aged 18-49 years of age. Black individuals had lower odds of CDK4/6i plus ET (OR: 0.76, 95% CI [0.58, 1.00]) compared to White individuals. Other characteristics associated with lower odds of CDK4/6i plus ET included patients with stage III disease (OR: 0.69, 95% CI [0.52, 0.92]), lower performance status (OR: 0.50, 95% CI [0.40, 0.62]), and Medicare insurance (OR: 0.73, 95% CI [0.30, 1.78]) compared to those with commercial and Medicaid insurance. After IPW adjustment, use of CDK4/6i plus ET as 1st -line treatment was associated with significantly longer median PFS compared to ET alone (27 vs. 17 months; hazard ratio [HR] = 0.61, p < 0.001). Median OS was 52 months in the CDK4/6i plus ET group and was 42 months with ET alone (HR = 0.74, p < 0.001).

Conclusion: In this real-world database, disparities in receiving 1st -line CDK4/6 inhibitors were seen by age, diagnosis stage, baseline performance status, comorbidity, and insurance status. In adjusted analysis, the use of 1st -line CDK4/6i plus ET yielded better PFS and OS rates than ET alone. Further efforts are essential to enhance equitable use of and access to this crucial drug class.

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来源期刊
CiteScore
12.00
自引率
0.00%
发文量
76
审稿时长
12 weeks
期刊介绍: Breast Cancer Research, an international, peer-reviewed online journal, publishes original research, reviews, editorials, and reports. It features open-access research articles of exceptional interest across all areas of biology and medicine relevant to breast cancer. This includes normal mammary gland biology, with a special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal covers preclinical, translational, and clinical studies with a biological basis, including Phase I and Phase II trials.
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