Clinical Study Of Salvage Treatment Strategy For Refractory Metastatic Breast Cancer

?Objective? Advanced metastatic breast cancer is a basically incurable disease with a median survival time of only 2 to 3 years.The main goal of treatment is to delay disease progression and prolong survival while maintaining a good quality of life.This study is divided into two parts.The first part aims to observe the efficacy and adverse reactions of docetaxel combined with bevacizumab multi-line salvage treatment for advanced recurrent metastatic breast cancer.The second part aims to explore the treatment options and efficacy of breast cancer liver metastases with severe liver dysfunction.?Methods? The first part:Retrospective analysis of 209 cases of breast cancer patients who have been treated with bevacizumab and confirmed by clinical pathology from May 2008 to May 2018.27 patients with metastatic breast cancer who received docetaxel combined with bevacizumab multiline therapy were screened out.We should analyze the effects and record adverse reactions of these patients,and calculate the progression-free survival at the same time.The second part:Retrospective analysis of 122 patients with liver metastasis and liver dysfunction from May 2003 to December 2012 was performed that the treatment methods were recorded,clinical effects were observed,and overall survival was calculated.A subgroup analysis was performed on 67 patients with advanced liver metastasis and severe liver dysfunction.The clinical efficacy and treatment options were observed.?Results? The first part:In 27 assessable patients,we were able to observe 11 partial responses and 15 stable diseases.Which the objective response rate was 40.7%,and median progressionfree survival time was 4 months(95% CI=2.9-5.1).Toxicity was generally mild.Grade 3 or 4 hematologic adverse effects were common.The nonhematologic adverse effects included diarrhoea(n=7),mucositis(n=4),fatigue(n=5)and alopecia(n=7).The second part:The median overall survival of 122 breast cancer patients after liver metastasis was 17.0 months(95% CI=14.3-19.7).The median overall survival after liver metastases progressed to liver dysfunction was 2.3 months(95% CI=1.3-2.9).107 patients in the whole group continued do antitumor treatment after liver dysfunction,of which 93 patients(76.2%)received chemotherapy(including targeted therapy)as the continuing treatment method,and 2 patients(1.6%)received chemotherapy combined with local treatment.12 patients(9.8%)received endocrine therapy.Among the patients receiving chemotherapy,70 patients(57.4%)received monotherapy and 25 patients(20.5%)received combination chemotherapy.The objective effective rate of 107 patients with breast cancer liver metastasis and liver dysfunction was 9.3%,and the disease control rate was 58.9%.In the subgroup of 67 patients with advanced liver metastasis and severe liver dysfunction,43 patients continued to receive anti-tumor therapy.The objective effective rate was 16.3% and the disease control rate was 55.8%.The median overall survival between the treatment group and untreated group after severe liver dysfunction(2.5 months vs 0.5 months,p < 0.05).Among the 43 cases,30 cases were treated with single-agent chemotherapy(or combined targeted therapy),6 cases with combined chemotherapy,and 7 cases received endocrine therapy.Subgroup chemotherapy included 10 cases of Taxanes,7 cases of platinum,9 cases of capecitabine,5 cases of gemcitabine,6 cases of vinorelbine,and 16 cases of trastuzumab combined therapy.?Conclusions? The first part:The combination of docetaxel and bevacizumab is an effective regiment for patients with multiline rescue treatment of advanced recurrent or metastatic breast cancer.Overall toxicity is acceptable.The second part:Liver dysfunction is a poor prognostic factor in breast cancer with liver metastasis.Patients with severe liver dysfunction caused by liver metastases from breast cancer can still receive salvage treatment,but it is recommended to select drugs with less hepatotoxicity,and to reduce the dosage according to the patient's own tolerance for the first time,try to use single drug,targeted drug,choose a reasonable treatment cycle and other individualized drug delivery mode.