Do patients with advanced breast cancer benefit from chemotherapy?

Abstract

Summary This study aimed to assess the proportion of patients with advanced breast cancer who report benefit from first-line palliative chemotherapy using a simple global measure of wellbeing and to identify factors predicting benefit. A consecutive series of women with advanced breast cancer undergoing first-line palliative chemotherapy was evaluated. The main outcome measure was patient report of overall wellbeing assessed at post-treatment interview. Physical, psychological and functional status were assessed using the Rotterdam Symptom Checklist (RSCL) on three occasions (pretreatment, at the start of the third cycle and post treatment). It was planned that treatment would be discontinued after six cycles (i.e. 18-24 weeks). One hundred and sixty patients started treatment, of whom 155 were assessable for quality of life. After treatment, 41 (26%) patients reported they felt better, 29 (19%) felt the same and 34 (22%) felt worse than they did before treatment. The other 51 (33%) patients either died or stopped attending the hospital before the post-treatment interview and were assigned as treatment 'failures'. Patients who reported feeling better after treatment had improvements in psychological distress (P < 0.0001), pain (P = 0.01), lack of energy (P = 0.02) and tiredness (P = 0.02), as well as improvement in functional status (P = 0.07). Feeling better was also correlated with disease response (P = 0.03). Feeling worse after treatment or treatment 'failure' was predicted by the pretreatment presence of a dry mouth (P = 0.003) and high levels of psychological distress (P = 0.03). Pretreatment lack of energy (P = 0.01), dry mouth (P = 0.02), presence of liver metastases (P = 0.03) and breathlessness (P = 0.03) predicted treatment 'failures'. The results of this study suggest that first-line palliative chemotherapy for advanced breast cancer confers benefit on a substantial proportion of patients, with about one-quarter feeling better after treatment and nearly a half feeling better or the same some 4-6 months after the start of treatment. Factors identified in this study may assist clinicians in deciding which patients should not be offered treatment, because of high risk of feeling worse or treatment 'failure'. This work now needs to be validated on a further cohort of women receiving chemotherapy for advanced breast cancer.

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

“…An objective response to chemotherapy (measured as a reduction in tumour bulk) is associated with improvement in both symptoms and performance status (Baum et al, 1980;Ramirez et al, 1998;Geels et al, 2000) and therefore clinicians would perceive these 2 goals as achievable. This study did not examine the influence of individual chemotherapeutic drugs on evaluations of the goals of palliative chemotherapy.…”

“…Initial disease-free interval and abnormal liver function tests/liver metastases have been identified as important prognostic factors (Namer et al, 1990;Falkson et al, 1991;Gregory et al, 1993) but evidence relating to other disease and patient characteristics is conflicting. Preliminary work has been undertaken to identify the factors predicting patient-reported benefit from first-line palliative chemotherapy using a simple global measure of well-being (Ramirez et al, 1998). High levels of psychological distress and the presence of a dry mouth prior to treatment were found to predict feeling worse after treatment.…”

Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

“…There are studies in which chemotherapy appears to enhance patients' quality of life (Thatcher et al, 1997;Stockler et al, 1998;Tannock, 1998;Geels et al, 2000;Doyle et al, 2001). Ramirez et al (1998) found that only 25% of the patients benefited from chemotherapy in her study, and there are several studies in which no improvement or even deterioration of quality of life was reported (Quantin et al, 2000;van Andel et al, 2000;Barras et al, 2001;Schiller et al, 2001). Values of patients thus become more important.…”

PRIMA-1 inhibits growth of breast cancer cells by re-activating mutant p53 protein

“…We therefore suggest that because most breast tumor cells with mtp53 fail to respond to first-line chemotherapeutic treatment (43), PRIMA-1 should be investigated as a potential alternative treatment strategy, either alone for tumors expressing high levels of p53, or in combination with anti-hormones, antiangiogenesis based antibodies, chemotherapeutic compounds, or vascular disrupting agents. We believe that such novel therapies may lead to a higher rate of success in the treatment of breast cancer.…”