Clinical Analysis Of Carboplatin-based Regimens As First-line Treatment Of Advanced Breast Cancer

Objective:To evaluate the efficacy and safety of regimens containing carboplatin as the first-line treatment for different molecular types of metastatic breast cancer,and the factors affecting the efficacy and prognosis were analyzed.Methods:From December 2013 to September 2019,177 patients with metastatic breast cancer were enrolled in the Affiliated Cancer Hospital of Guangxi Medical University.All patients had indications for chemotherapy,and received the chemotherapy containing carboplatin as the first-line treatment.The dosage and usage of carboplatin were AUC=5 or 400mg/m~2,intravenous drip,D1;the combined chemotherapy drugs included taxanes,pemetrexed,gemcitabine,vinorelbine or capecitabine,and the dosage and usage were conventional.Every 21 days per cycle for all the regimens;the adverse reactions were evaluated every cycle,and the efficacy was evaluated every 2 cycles.Each patient received at least 2 cycles of treatment.The main observation indexes were PFS,and the secondary observation indexes were ORR,DCR and adverse reactions.The data were processed by SPSS 25.0.The counting data were expressed by the number of cases(constituent ratio).The rates were compared by Chi-square test or Fisher exact probabilities.Univariate and multivariate Logistic regression was used to analyze the factors affecting ORR and DCR.Kaplan-Meier estimates was used to draw survival curve and Log-rank test was used for survival analysis.Cox’s proportional hazard regression model was used for univariate and multivariate analysis of possible prognostic factors.P<0.05 was considered statistically significant.Results:1.177 patients were all female,with a median age of 49 years(range 23-75 years).27 patients were TNBC(15.25%),80 patients were HER-2 positive(45.20%),and 121 patients were HR positive(68.36%).The ORR of the whole group was 49.72%.The ORR of each molecular typing subgroups was:TNBC group was 44.44%(12/27),HER-2 positive(HR+/HR-)group was 57.50%(46/80),HR positive/HER-2 negative group was 42.86%(30/70),respectively.There was no significant difference in ORR between each subgroup(P>0.05).At the same time,there was no significant difference in ORR and DCR among subgroups such as different age,ECOG score,menstrual status,HR status,HER-2status,TNBC or non-TNBC,molecular types,combination regimens,DFS of primary diagnosed non-metastatic breast cancer,use of anthracyclines and/or taxanes in neoadjuvant/adjuvant stage,sensitivity of anthracyclines and/or taxanes,use of trastuzumab in HER-2 positive patients and use of rh-endostatin in HER-2 negative patients(all P>0.05).The results of univariate analysis showed that the clinicopathological features above-mentioned were not the factors affecting ORR(all P>0.05).2.The median follow-up time was 20.47 months,and the m PFS of the whole group was 10.40 months(95%CI,8.77-12.03 months).The m PFS of each molecular typing subgroup was:TNBC group was 6.10 months(95%CI,5.52-6.68months),HER-2 positive(HR+/HR-)group was13.70 months(95%CI,8.61-18.79months),HR positive/HER-2 negative group was 10.40 months(95%CI,7.49-13.31months),respectively.The m PFS of TNBC group was significantly shorter than that of HER-2positive group(P=0.006).COX multivariate analysis show that ECOG score≥2 was a prognostic risk factor for PFS(HR,2.774;95%CI,1.253-6.142,P=0.012),and compared with carboplatin combined with taxanes,carboplatin combined with pemetrexed was a prognostic risk factor for PFS(HR,1.998;95%CI,1.170-3.413;P=0.011).3.The high incidence rate of grade 3-4 adverse reactions in the whole group were:leukopenia(14.69%),neutropenia(19.21%)and anemia(13.56%).All the adverse reactions returned to normal after treatment,and there was no treatment-related death in the whole group.Conclusion:1.Carboplatin-containing regimens is effective and safe as the first-line treatment of metastatic breast cancer.2.Carboplatin-containing regimens as the first-line treatment for different molecular types of advanced breast cancer are all highly efficient,and there was no significant difference in ORR and DCR among different molecular types.3.Molecular types of advanced breast cancer is not an independent prognostic factor of PFS for carboplatin-containing regimens as the first-line treatment.4.ECOG score and the choice of regimens combined with carboplatin are the independent prognostic factors of PFS.ECOG score≥2 and carboplatin combined with pemetrexed are prognostic risk factors of PFS.