Late lines of treatment benefit survival in metastatic breast cancer in current practice?

Planchat, E.; Abrial, Catherine; Thivat, Émilie; Mouret-Reynier, Marie Ange; Kwiatkowski, Fabrice; Pomel, Christophe; Wang-Lopez, Q.; Chollet, Philippe; Nabholtz, Jean‐Marc; Durando, Xavier

doi:10.1016/j.breast.2011.07.010

Cited by 23 publications

(14 citation statements)

References 22 publications

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“…At present, there is various supports for the use of third-line chemotherapy, and even beyond the third-line recent retrospective studies suggest a potential gain, since each line can contribute to longer survival 14-16. The heterogeneity of the disease and the variability in individual presentations means that no widely accepted specific treatment guidelines exist.…”

Section: Discussionmentioning

confidence: 99%

Eribulin Mesylate in Pretreated Breast Cancer Patients: A Multicenter Retrospective Observational Study

Gamucci¹,

Michelotti²,

Pizzuti³

et al. 2014

J. Cancer

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Background: Eribulin was recently approved in patients progressing after being treated with anthracyclines and taxanes and after two or more chemotherapy lines for advanced disease.Objectives: This multicenter observational retrospective study was performed in order to evaluate activity and tolerability of eribulin in real-world patient population.Methods: 133 advanced breast cancer patients pretreated with ≥ 2 chemotherapy lines for metastatic disease were retrospectively enrolled in the observational trial in 11 italian cancer centres.Results: A median of 5 cycles of eribulin (range, 1-15) were administered. Twenty-eight partial responses were observed, for an overall response rate of 21.1% (95%CI,14.1-28.0). A stable disease was recorded in 57 patients (42.8%), and a clinical benefit (response or stable disease lasting ≥ six months) was observed in 51 patients (38.3%, 95%CI, 30.1-46.6). The subgroup analysis showed that a significant improvement in term of partial response and clinical benefit was achieved when eribulin was administered in HER-2 negative tumors (p=0.01 and p=0.004, respectively) and when it is given as third-line (p=0.09 and p=0.02, respectively). Toxicity was manageable; fatigue is the most common side effect observed, usually of low-grade, and clearly cumulative-dose related.Conclusions: In this retrospective, observational analysis eribulin confirmed its efficacy and manageable tolerability even in real-world population and in heavily pretreated patients.

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Section: Discussionmentioning

confidence: 99%

Eribulin Mesylate in Pretreated Breast Cancer Patients: A Multicenter Retrospective Observational Study

Gamucci¹,

Michelotti²,

Pizzuti³

et al. 2014

J. Cancer

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“…The Akt-mTOR pathway plays a central role which may interact with the metabolism pathway of lipids/TG. In our previous database (META), each line determined a median survival close to 1 year, with a period of treatment of about 4 months (6 CT cycles), and a follow-up until progression and onset of a new line [23]. This was comparable to the HT-based line, with the benefit of an all-oral therapy and only an outpatient follow-up.…”

Section: Discussionmentioning

confidence: 89%

“…For the case-control study, we used another database including 530 MBC patients called ‘META' [23], stratified by duration of each treatment line and fractional survival by line, classified by chronological ranking. This work had been approved by the Inter-Regional Ethics Committee of the Rhône-Alpes-Auvergne Clinical Investigation Center (N_IRB5044/CEeCICeGREN-11/03).…”

Section: Methodsmentioning

confidence: 99%

Everolimus in Metastatic Breast Cancer: Clinical Experience as a Late Treatment Line

Pouget

Abrial²,

Planchat³

et al. 2015

Oncology

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Background: Everolimus (Afinitor®) plus exemestane are indicated for hormone receptor-positive, HER2/neu-negative metastatic breast cancer (MBC), in menopausal women without symptomatic visceral disease after recurrence or progression following aromatase inhibitors. But everolimus efficacy as late treatment has not been explored. Methods: Sixty-three MBC patients progressing under hormonotherapy (HT; n = 30) or after chemotherapy (CT; n = 32) received everolimus plus HT (EHT) and were analyzed for safety, efficacy and overall survival (OS). This cohort was compared with our previous 530 MBC patients stratified by line (PMID 21852136). Results: The median duration of EHT was 27.8 weeks at 5-10 mg/day until clinical progression or toxicity. Median OS was not reached (median follow-up 18 months). Twelve-month survival was 100, 79 and 49% for patients treated with 0 (n = 13), 1-2 (n = 18) and >3 CT (n = 32), respectively. Median time-to-treatment failure was 6.4 months. In 62 EHT patients randomly matched 1:7 with 421 previous patients for age and number of CT, OS improved compared with patients receiving a new CT (p = 0.062). In patients pretreated with <2 CT, EHT gave a better OS than in those with a new CT (p = 0.026). Conclusions: These results may support the use of EHT whatever the number of previous lines.

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“…Thus, patients were treated by chemotherapy during only 36% of OS duration, suggesting the possibility of better QoL. However, toxicities of given treatments and QoL were not systematically evaluated; approximately 5% of patients stopped chemotherapy due to toxicity [Planchat et al 2011].…”

Section: Number Of Patientsmentioning

confidence: 99%

Which patients with metastatic breast cancer benefit from subsequent lines of treatment? An update for clinicians

et al. 2013

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The outcome of patients with metastatic breast cancer (MBC) has clearly improved over the past decades and the proportion of women living with their disease for several years is increasing. However, the usefulness of multiple lines of treatment is still debated and under evaluation. The available data from both randomized trials and large retrospective series are reviewed and discussed in order to analyze management practices, with emphasis on potential prognostic and predictive factors for clinical outcome. At present, evidence-based medicine provides some support for the use of second-line and to a lesser degree and in selected cases, third-line chemotherapy in human epidermal growth factor receptor 2 (HER2) negative MBC. Beyond third-line treatment, messages from recently reported retrospective studies also suggest a clear potential gain for women receiving further therapies after disease progression, since each line can contribute to a longer survival. In HER2-positive disease, the data from observational and retrospective studies support a clinical benefit from the use of trastuzumab beyond disease progression and emerging evidences from randomized controlled trials are leading to the introduction of newer HER2-targeted therapies in multiple lines. The question 'How many lines of treatment should we give patients?' clearly needs further research through prospective, high-quality clinical trials, aiming for a better definition of factors with prognostic and predictive role. In the meantime, the 'optimal' treatment strategy should probably be to use as many therapeutic options as possible, either in sequence or combination, to keep the best efficacy/toxicity balance, considering MBC as a chronic disease.

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Late lines of treatment benefit survival in metastatic breast cancer in current practice?

Cited by 23 publications

References 22 publications

Eribulin Mesylate in Pretreated Breast Cancer Patients: A Multicenter Retrospective Observational Study

Eribulin Mesylate in Pretreated Breast Cancer Patients: A Multicenter Retrospective Observational Study

Everolimus in Metastatic Breast Cancer: Clinical Experience as a Late Treatment Line

Which patients with metastatic breast cancer benefit from subsequent lines of treatment? An update for clinicians

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