Background:The treatment of hormone receptor positive (HR+), HER-2 negative metastatic breast cancer (MBC) has radically changed over the last few years. CDK4/6 inhibitors combined with endocrine therapy have become the standard of care as a front-line therapeutic approach, conferring a significant improvement in progression-free survival and overall survival compared to traditional endocrine therapy (ET) alone. However, the wide administration of these drugs in clinical practice paved the way for the emergence of new intrinsic and acquired mechanisms of resistance that seem to compromise second-line treatment effectiveness. In this context, fulvestrant monotherapy appears disqualified.Materials and Methods:we evaluated a population of 30 women currently treated in our oncology unit with HR+/HER2- metastatic breast cancer, receiving fulvestrant 500 mg every 28 days after progression to first-line therapy with CDK 4/6 inhibitors combined with aromatase inhibitors.Results:Of 30 patients observed, 23 progressed to fulvestrant with a median PFS of 3.7 months (range 1–9.7 months).Conclusions:our real-life experience suggests that second-line fulvestrant monotherapy confers very poor disease control and is quite an inadequate therapeutic option. CDK4/6i administration beyond progression could possibly be considered as more valid option, in the absence of targetable mutations or newer, more effective drugs.
背景：过去几年，激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER-2-）转移性乳腺癌（MBC）的治疗发生了根本性变化。相较于传统单一内分泌治疗（ET），CDK4/6抑制剂联合内分泌疗法已成为一线治疗标准方案，能显著改善患者的无进展生存期和总生存期。然而，这类药物在临床实践中的广泛应用，为新的内在性与获得性耐药机制的出现创造了条件，这些机制可能影响二线治疗的有效性。在此背景下，氟维司群单药疗法已显不足。 材料与方法：本研究评估了30例目前在我们肿瘤科接受治疗的HR+/HER2-转移性乳腺癌女性患者，这些患者在CDK4/6抑制剂联合芳香化酶抑制剂一线治疗进展后，每28天接受500 mg氟维司群治疗。 结果：在观察的30例患者中，23例出现疾病进展，其中位无进展生存期为3.7个月（范围1-9.7个月）。 结论：我们的真实世界经验表明，二线氟维司群单药疗法的疾病控制效果极差，并非合适的治疗选择。在缺乏可靶向突变或更新、更有效药物的情况下，进展后继续使用CDK4/6抑制剂可能是更有效的治疗选择。
肿瘤(癌症)患者之家