Hormon reseptör pozitif HER2-negatif metastatik meme kanseri tedavisinde üçüncü ve sonraki basamaklarda everolimus/eksemestan tedavisinin etkinliği ve toksisitesi

Amaç: Siklin bağımlı kinaz 4-6 inhibitörü ve fulvestrant gibi tedavilerin tek başına ya da kombinasyon halinde kullanılmasının hormone reseptör (HR)-pozitif metastatik meme kanseri (MMK) tedavisinde daha etkin olduğunun gösterilmesiyle günlük pratikte everolimus/eksemestan tedavisi daha ileriki basamaklarda kullanılmaya başlamıştır. Bu çalışmanın amacı HR-pozitif HER2-negatif MMK tedavisinde üçüncü ve sonraki basamaklarda everolimus/eksemestan kombinasyon tedavisinin etkinliğini ve toksisitelerini gerçek yaşam verileri ile değerlendirmektir.Yöntemler: Bu çalışma retrospektif kohort çalışmasıdır. Kasım 2013 - Mart 2020 tarihleri arasında merkezimizde HR-pozitif HER2-negatif MMK tanısıyla everolimus/eksemestan kombinasyon tedavisi alanlar çalışmaya dahil edilmiştir. Hastaların klinikopatolojik özellikleri ve tedavi ilişkili toksisiteler retrospektif olarak incelenmiştir.Bulgular: Çalışmaya dahil edilen 33 hastanın ortanca yaşı 59’du (30-77). Hastaların 23’ünün (%69,7) visseral metastazı varken 10 (%30,3) hastanın yalnızca kemik metastazı vardı. Everolimus/eksemestan tedavisi 22 (%66,6) hastaya üçüncü basamakta, 11 (%33,3) hastaya ise sonraki basamaklarda verilmişti. Ortanca takip süresi 15.5 (0,3-35,5) aydı. Ortanca progresyonsuz sağkalım (PS) 7,0 (5,1-9,0, 95% CI) ay; ortanca genel sağkalım ise 21,3 (13,4-29,2, 95% CI) aydı. Yalnızca kemik metastazı olan hastalarla visseral metastazı olan hastalar arasında ortanca PS açısından fark yoktu (7,2–6,4 ay; P=0,96).Sonuç: Everolimus/eksemestan kombinasyonu HR-pozitif HER2-negatif MMK tedavisinde ileriki basamaklarda da etkin ve tolere edilebilir bir tedavi seçeneğidir.

Anahtar Kelimeler:

Everolimus, Eksemestan, Meme kanseri

Efficacy and toxicity of everolimus plus exemestane in third and later lines treatment of hormone receptor-positive, HER2-negative metastatic breast cancer

Aim: In daily practice, everolimus plus exemestane therapy has begun to be used in the later-lines as it has been demonstrated that treatments such as cyclin-dependent kinase (CDK) 4/6 inhibitors and fulvestrant, alone or in combination, are more effective in hormone receptor (HR)-positive metastatic breast cancer (MBC). The aim of this study is to evaluate the efficacy and toxicity of everolimus plus exemestane in the third line and later-lines on HR-positive Human Epidermal Growth Factor Receptor 2 (HER2)-negative MBC treatment with real-life data.Methods: Patients who received everolimus plus exemestane with the diagnosis of HR-positive and HER2-negative MBC between November 2013 and March 2020 were included in this retrospective cohort study. Clinicopathological characteristics of patients and treatment related toxicities were evaluated retrospectively.Results: The median age of the 33 patients included in the study was 59 (30-77) years. Twenty-three (69.7%) of the patients had visceral metastasis, while 10 (30.3%) had only bone metastasis. Everolimus plus exemestane was used in the third line in 22 (66.6%) patients and later-lines in 11 (33.3%) patients. The median follow-up time was 15.5 months (0.3-35.5). Median progression-free survival (PFS) and overall survival (OS) were 7.0 (5.1-9.0, 95% CI) months and 21.3 (13.4-29.2, 95% CI) months, respectively. Median PFS of patients with only bone metastasis and visceral metastasis were similar (7.2 vs 6.4 months, P=0.96).Conclusion: Everolimus plus exemestane is an effective and tolerable treatment choice in the later-lines in the treatment of HR-positive HER2-negative MBC.

Keywords:

Everolimus, Exemestane, Breast cancer,

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