Purpose: Endocrine therapy is one of the main treatment options for hormone\nreceptor (HR)-positive advanced breast cancer (ABC). However, whether\nthe combination of endocrine therapy with chemotherapy is practicable and\nmore effective than endocrine therapy alone remains unknown. The aim of\nthis study was to investigate the clinical efficacy of the aromatase inhibitors\n(AIs) combined with metronomic capecitabine to provide the clinical evidence\nfor further research in patients with HR-positive ABC. Methods: Data\nfrom 407 patients with HR-positive ABC were retrospectively analyzed. A total\nof 305 patients were given AIs alone, and 102 patients were given AIs plus\ncapecitabine as first-line treatment. Progression-free survival (PFS) was the\nprimary endpoint. Results: The median follow-up for all patients was 47.0\nmonths (range, 3 - 119 months). The median overall survival (OS) and PFS\nwere 52.0 months and 24.2 months, respectively. The median PFS in the\ncombination group was significantly longer than that in the AIs group (22.0\nmonths vs. 14.0 months, p = 0.002). Additionally, patients in the combination\ngroup had significantly longer OS than patients in the AI group (66.0 months\nvs. 49.0 months, p = 0.003). Multivariate analysis showed that combination\ntherapy was a significant favorable predictor for PFS and OS. Furthermore,\nyoung age (<40 years), low estrogen receptor (ER) expression level (<40%),\npresence of visceral metastasis, prior adjuvant AI use and long disease-free\ninterval (DFI) (>24 months) improved the benefit from combination therapy.\nConclusions: AIs plus metronomic capecitabine significantly improves PFS\nand OS in patients with HR-positive ABC. Thus, chemo-endocrine therapy\nshould be further explored.
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