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Metastatic Breast Cancer
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John Hodges
Jul 11, 2016
What single agent has a survival benefit? Eribulin
Syed Sameer Nasir
Jul 24, 2016
In advanced breast cancer, sequential use of single agent chemotherapy is preferred as it offers less toxicity with similar survival as combination chemotherapy(1), unless patient is symptomatic with visceral metastasis where combination therapy is preferred due to higher response rate, which may justify the risks of added toxicity. Also, chemotherapy beyond first line is associated with responses in fewer patients. However, the value of second and subsequent lines of chemotherapy are better appreciated with other outcome measures, such as the proportion of patients surviving at 1 and 2 years, and QOL improvements.(2)
Here are some significant studies leading to recommendation for different chemotherapy regimens in advanced breast cancer with information on progression free survival (PFS) and overall survival (OS).
1. Chan S, Friedrichs K, Noel D, et al. Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer. J Clin Oncol 1999
Median time to progression: docetaxel group, 26 weeks; doxorubicin, 21 weeks; p value not significant.
Median overall survival: docetaxel, 15 months; doxorubicin, 14 months
2. Gasparini G, Dal Fior S, Panizzoni GA, et al. Weekly epirubicin versus doxorubicin as second line therapy in advanced breast cancer. A randomized clinical trial. Am J 3 Clin Oncol 1991
Median TTP: doxorubicin, 23 weeks; epirubicin, 19 weeks (P = 0.063)
Median OS: doxorubicin, 47 weeks; epirubicin, 44 weeks
3. Perez EA, Vogel CL, Irwin DH, et al. Multicenter phase II trial of weekly paclitaxel in women with metastatic breast cancer. J Clin Oncol 2001
Median TTP: 4.7 months; Median overall survival: 12.8 months.
4. Bajetta E, Procopio G, Celio L, et al. Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. J Clin Oncol 7 2005
Median TTP was 4.1 months; Median OS: 6 months.
5. Feher O, Vodvarka P, Jassem J et al. First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicenter, randomized, phase III study. Ann Oncol. 2005
Median TTP: epirubicin 6.1 months; gemcitabine 3.4 months (P=0.0001) Median OS: epirubicin 19.1 months, gemcitabine 11.8 months (P=0.0004)
6. Cortes J, O'Shaughnessy J, Loesch D, et al. Eribulin monotherapy versus treatment of physician's choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 2011
Median OS: eribulin,13·1 months; treatment of physician's choice 10·6 months (p=0·041)
References:
1. Dear RF, McGeechan K, Jenkins MC et al. Combination versus sequential single agent chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev. 2013
2. F. Cardoso, A. Di Leo, C. Lohrisch et al. Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol (2002)
Dec 31, 2024
Pending Moderator approval.
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John Hodges
Jul 11, 2016
Syed Sameer Nasir
Jul 24, 2016
Dec 31, 2024
Pending Moderator approval.