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某些研究发现，双膦酸盐和地诺单抗作为早期乳腺癌术后患者的辅助治疗药物，可能改善癌症结局。不过，目前尚不明确早期乳腺癌术后患者对于这些药物的较低剂量（通常用于骨质疏松）能否获益。 2020年6月23日，美国癌症学会《癌症》在线发表德克萨斯大学MD安德森癌症中心、新墨西哥州长老会医疗集团的大数据研究报告，调查了较低剂量双膦酸盐或地诺单抗对老年早期乳腺癌女性生存结局的影响。 该队列回顾研究通过美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）和德克萨斯癌症登记中心与联邦医疗保险（Medicare）关联数据库，纳入年龄≥66岁的早期乳腺癌女性3万7724例，对乳腺癌诊断后2年内接受用于骨质疏松剂量双膦酸盐或地诺单抗与总生存和乳腺癌相关生存的相关性进行回顾分析。通过多因素比例风险回归模型以及倾向评分匹配对其他影响因素进行校正。 结果，其中7925例（21%）接受了至少6个月的双膦酸盐或地诺单抗治疗，其中单用双膦酸盐6898例（80.7%）、单用地诺单抗1204例（15.2%）、双膦酸盐＋地诺单抗323例（4.1%）。 中位随访64个月，对其他影响因素进行校正后，接受与未接受双膦酸盐的患者相比：
生存获益主要见于II期和III期乳腺癌患者。 接受与未接受地诺单抗的患者相比：
因此，该研究结果表明，骨质疏松推荐剂量双膦酸盐可能改善绝经后早期乳腺癌女性的生存结局。 Cancer. 2020 Jun 23. Online ahead of print. Survival in older women with early stage breast cancer receiving low-dose bisphosphonates or denosumab. Suarez-Almazor ME, Herrera R, Lei X, Chavez-MacGregor M, Zhao H, Giordano SH. The University of Texas MD Anderson Cancer Center, Houston, Texas; Presbyterian Medical Group, Albuquerque, New Mexico. BACKGROUND: Bisphosphonates and denosumab, as adjuvant therapy in breast cancer, have been associated in some studies with improved cancer outcomes. The potential benefits of these drugs used at the lower doses commonly given for osteoporosis have not been established. The objective of this study was to investigate the association between therapy with bone-modifying agents (BMAs) and survival in older women with early breast cancer. METHODS: The authors conducted a retrospective cohort study of women aged ≥66 years with breast cancer who were included in the Surveillance, Epidemiology, and End Results and Texas Cancer Registry Medicare-linked databases. Associations were examined between the receipt of BMAs at dosages indicated for osteoporosis within 2 years after diagnosis and overall and breast cancer-specific survival. Cox proportional hazards models and propensity score adjustment and matching were used for the analyses. RESULTS: Of the 37,724 women included, 7925 (21%) received at least 6 months of a BMA within the first 2 years of breast cancer diagnosis, including bisphosphonates only in 6898 women (80.7%), denosumab only in 1204 (15.2%), and both classes of BMAs in 323 (4.1%). The median follow-up was 64 months. The receipt of a bisphosphonate was associated with improved overall survival (hazard ratio [HR], 0.87; 95% CI, 0.82-0.93) and breast cancer-specific survival (HR, 0.77; 95% CI, 0.64-0.92) after multivariable adjustment. Benefits were primarily seen for patients who had stage II and III disease. No benefits were observed with denosumab (stage II: HR, 1.05 [95% CI, 0.90-1.22]; stage III: HR, 1.09 [95% CI, 0.66-1.82]). CONCLUSIONS: Bisphosphonates at the doses recommended for osteoporosis are associated with improved survival in older postmenopausal women with early breast cancer. KEYWORDS: adjuvant therapy; bisphosphonates; breast cancer; denosumab; osteoporosis PMID: 32573777 DOI: 10.1002/cncr.33035
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