JCO：乳腺癌蒽环类化疗方案的使用率呈下降趋势

gexiaom

JCO：乳腺癌蒽环类化疗方案的使用率呈下降趋势
2012-05-23
为了调查蒽环类和紫杉类为基础的化疗方案在乳腺癌患者中的使用情况，来自美国安德森癌症中心的Giordano等人进行了研究。研究结果近期在线发表在JCO上。

此项研究纳入的患者来自1998年至2009年的国家医保人群样本库和Marketscan数据库。这些患者在手术前3个月和手术后12月曾接受化疗。化疗方案被分为含蒽环类或紫杉类两类。分段回归模型用以确定化疗使用率的拐点。多变量logistic回归模型用于评估患者自身特点对选择化疗方案的影响。

最终此项研究纳入了来自医保人群队列的4,458例患者和私人保险队列的30,422例患者。研究发现在2005年以后，紫杉类为基础化疗方案的使用率急剧 上升，而蒽环类为主的化疗方案则呈现明显下降趋势。到2008年，在医保人群队列中，51％的患者接受紫杉类为基础的化疗方案，32％患者接受蒽环类为主 的化疗方案。到2008年底，大多数年龄低于65岁的患者接受以紫杉类为基础的化疗方案。虽然年龄小于35岁的患者较少采用以紫杉类为基础的化疗方案，但接受21基因复发评分测试和曲妥珠单抗治疗的患者则更有可能采用紫杉类为基础的化疗方案。

由此可得出结论：以蒽环类药物为主的化疗方案使用率有所下降。大多数乳腺癌患者目前更倾向于采用以紫杉烷类化合物为基础的化疗方案。这一变化对患者治疗效果的潜在影响目前还是个未知数。

gexiaom

相关文献
Decline in the Use of Anthracyclines for Breast Cancer.
J Clin Oncol 2012;:

Giordano SH Lin YL Kuo YF Hortobagyi GN Goodwin JS

The University of Texas MD Anderson Cancer Center, Houston; and The University of Texas Medical Branch, Galveston, TX.

Abstract
PURPOSETo determine the patterns of use of anthracycline- and taxane-based chemotherapy for breast cancer treatment. METHODSClaims from a 5% national Medicare sample and from a nationally representative claims database (Marketscan) from 1998 to 2009 were used. Patients with International Classification of Diseases (ICD), ninth revision, codes indicating breast cancer, ICD and Common Procedural Terminology codes indicating breast surgery, and claims for chemotherapy between 3 months before and 12 months after surgery comprised the study cohort. Chemotherapy was classified as anthracycline-based or taxane-based, and the percentages of use were calculated. Piecewise regression models were used to identify the inflection points in the rates of chemotherapy use. The effect of patient characteristics on receiving different types of chemotherapy was estimated by multivariable logistic regression models.ResultsA total of 4,458 patients were included in the Medicare cohort and 30,422 in the private insurance cohort. After 2005, a sharp increase in the use of taxane-based chemotherapy and a decline in anthracycline-based chemotherapy was seen. By 2008 in the Medicare cohort, 51% of patients received taxane-based and 32% received anthracycline-based chemotherapy. By the end of 2008, the majority of patients younger than 65 years were also receiving taxane-based chemotherapy. Patients younger than 35 years were less likely to be treated with a taxane-based regimen, whereas patients who underwent 21-gene recurrence score testing and those treated with trastuzumab were more likely to receive taxane-based chemotherapy. CONCLUSIONThe use of anthracycline-based chemotherapy has declined, and the majority of patients with breast cancer are instead receiving taxane-based chemotherapy. The potential impact on patient outcomes is unknown.