Hormonal therapy might be a better choice as maintenance treatment than capecitabine after response to first-line capecitabine-based combination chemotherapy for patients with hormone receptor-positive and HER2-negative, metastatic breast cancer

Abstract

BackgroundBoth hormonal therapy (HT) and maintenance capecitabine monotherapy (MCT) have been shown to extend time to progression (TTP) in patients with metastatic breast cancer (MBC) after failure of taxanes and anthracycline-containing regimens. However, no clinical trials have directly compared the efficacy of MCT and HT after response to first-line capecitabine-based combination chemotherapy (FCCT) in patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer.MethodsWe retrospectively analyzed the charts of 138 HR-positive and HER2-negative MBC patients who were in non-progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, in Beijing, China. The median number of first-line chemotherapy cycles was 6 (range, 4–8); combined agents included taxanes, vinorelbine, or gemcitabine. Of these 138 patients, 79 received MCT, and 59 received HT. Single-agent capecitabine was administered at a dose of 1250 mg/m2 twice daily for 14 days, followed by a 7-day rest period, repeated every 3 weeks. Of the 59 patients who received HT, 37 received aromatase inhibitors (AIs), 8 received selective estrogen receptor modulators (SERMs), and 14 received goserelin plus either AIs or SERMs. We then compared the MCT group and HT group in terms of treatment efficacy.ResultsWith a median follow-up of 43 months, patients in the HT group had a much longer TTP than patients in the MCT group (13 vs. 8 months, P = 0.011). When TTP was adjusted for age, menopausal status, Karnofsky performance status score, disease-free survival, site of metastasis, number of metastatic sites, and response status after FCCT, extended TTP was still observed for patients in the HT group (hazard ratio: 0.63; 95% confidence interval: 0.44–0.93; P = 0.020). We also observed a trend of overall survival advantage for patients in the HT group vs. patients in the MCT group, but the difference was not significant (43 vs. 37 months, P = 0.400). In addition, patients in the HT group generally tolerated the treatment well, whereas patients in the MCT group experienced grades 3–4 adverse events, the most frequent of which were hand-foot syndrome (15.8%) and hematologic abnormalities (7.6%).ConclusionFor HR-positive and HER2-negative MBC patients, HT might be considered a treatment after response to FCCT but prior to MCT as a long-term administration.

Impact of hormone receptor status and distant recurrence-free interval on survival benefits from trastuzumab in HER2-positive metastatic breast cancer

“…Previous reports suggested that high ER expression (≥30%) was associated with a reduced probability of tumour response to trastuzumab plus chemotherapy 11 . However, progression-free survival was significantly improved when maintenance endocrine therapy was added to trastuzumab in ER-positive MBC patients 17 . More importantly, the current analysis provides real-world evidence that DRFI can serve as a reliable stratification factor for OS benefit analysis from trastuzumab-containing palliative therapy in HR+HER2+ MBC, demonstrating that late recurrent (DRFI > 5 years) patients derived a less pronounced survival benefit than their early recurrent counterparts.…”

Weekly taxane–anthracycline combination regimen versus tri-weekly anthracycline-based regimen for the treatment of locally advanced breast cancer: a randomized controlled trial

“…However, the ABCSG-14 trial included patients with diseases at any tumor stage, whereas the present study focused on those with locally advanced breast cancer who may have a poorer prognosis. Additionally, the predominant population in the present study was positive for hormone receptor, which was a predictive factor for a low response to NACT [ 18 , 19 ].…”

Efficacy of fulvestrant 500 mg in Chinese postmenopausal women with advanced/recurrent breast cancer and factors associated with prolonged time-to-treatment failure

“…[ 1 ] Sequential endocrine treatment is still considered the preferred strategy for treating hormone-sensitive metastatic breast cancer, and new treatment regimens are prescribed when progression occurs. [ 5 ] Endocrine treatment may include selective estrogen receptor modulators (SERMS) such as tamoxifen, toremifene and fulvestrant, and aromatase inhibitors such as anastrozole. [ 5 , 6 ] Other drugs, including the CDK4/6 inhibitors palbociclib and ribociclib, and pictilisib and buparlisib that target the phosphatidylinositol-3-kinase (PI3K)/Akt and the mammalian target of rapamycin (mTOR) signaling (PI3K/AKt/mTOR) pathway, are sometimes used in conjunction with fulvestrant.…”

“…[ 5 ] Endocrine treatment may include selective estrogen receptor modulators (SERMS) such as tamoxifen, toremifene and fulvestrant, and aromatase inhibitors such as anastrozole. [ 5 , 6 ] Other drugs, including the CDK4/6 inhibitors palbociclib and ribociclib, and pictilisib and buparlisib that target the phosphatidylinositol-3-kinase (PI3K)/Akt and the mammalian target of rapamycin (mTOR) signaling (PI3K/AKt/mTOR) pathway, are sometimes used in conjunction with fulvestrant. Such combination endocrine therapy has been suggested to be more effective for hormone-sensitive breast cancer than monotherapy because it balances the benefits of endocrine therapy while also managing toxicity levels.…”