What is the evidence for rechallenging with anthracyclines or taxanes in metastatic breast cancer? A review of the data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1072-1072
Author(s):  
J. Krell ◽  
C. Harper-Wynne ◽  
D. Miles ◽  
V. Misra ◽  
S. Cleator ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Safety Data ◽  
Metastatic Breast ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Sequence ◽  
Pubmed Database ◽  
Current Evidence Base

1072 Background: Anthracyclines and taxanes are widely used in the adjuvant setting for high risk, early stage breast cancer. This raises the issue of what is the optimal therapy for those patients who relapse, and what the potential role, if any, there is for rechallenge with these agents. The current evidence base for rechallenging with anthracyclines/anthracediones and taxanes in metastatic breast cancer (MBC) is examined in this study. Methods: Medline/Pubmed database searches were performed upto October 2008 to identify studies in which patients (pts) were rechallenged with anthracyclines/anthracediones or taxanes in MBC. Results: The efficacy data, as well as the safety data relating to neurotoxicity and cardiotoxicity from these studies, are summarized in the Table. Twenty-seven studies were identified (20=anthracycline/anthracedione, 7= taxane) of which only two were prospective studies. Both were small (n= 74 & 51) and related to anthracycline rechallenging. Conclusions: Evidence exists to support rechallenging with anthracyclines and taxanes. However, there are few prospective data on reexposure to taxanes and no data comparing anthracyclines versus taxanes following adjuvant exposure to both agents, supporting the need for clinical trials in this area. Such trials should ideally incorporate a cross-over design at treatment failure, which would shed light on the optimal sequence in which these agents should be administered. [Table: see text] No significant financial relationships to disclose.

scholarly journals Late Administration of Trastuzumab Emtansine Might Lead to Loss of Chance for Better Outcome in Patients with HER2-Positive Metastatic Breast Cancer

Breast Care ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Luis Manso ◽  
Alfonso Sanchez-Muñoz ◽  
Isabel Calvo ◽  
Yann Izarzugaza ◽  
Jessica Plata ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Safety Data ◽  
Growth Factor Receptor ◽  
Metastatic Breast ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Optimal Sequence ◽  
Number Of Patients ◽  
Epidermal Growth

The optimal sequence of anti-human epidermal growth factor receptor 2 (HER2) therapies in metastatic breast cancer (MBC) is still undetermined. Physicians must therefore make decisions based on clinical trials and their own experience for the best treatment sequence in these patients. The objective of this review is to summarize the efficacy and safety data for trastuzumab emtansine (T-DM1) in patients with MBC. Additionally, the concept of ‘loss of chance for a better outcome' is investigated. It applies to patients who are not receiving the best possible treatment for their disease. Physicians should strive to offer the best possible care, although getting optimal results in each individual patient is not guaranteed. Lastly, the number of patients with MBC lost per treatment line is evaluated. We conclude that both concepts reinforce the importance of giving the most active treatments as soon as possible in the course of disease to secure the longest possible survival for HER2-positive MBC patients.

Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.

1995 ◽  
Vol 13 (4) ◽  
pp. 858-868 ◽  
Author(s):  
R P McQuellon ◽  
H B Muss ◽  
S L Hoffman ◽  
G Russell ◽  
B Craven ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Metastatic Breast Cancer ◽  
Life Expectancy ◽  
Metastatic Disease ◽  
Patient Preferences ◽  
Early Stage ◽  
Metastatic Breast ◽  
High Dose

PURPOSE The purpose of this study was to elicit preferences for the treatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted that quality of life, demographic, and treatment variables would have an impact on patient preferences. PATIENTS AND METHODS One hundred fifteen patients with stage 1-IIIA breast cancer were interviewed. All patients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patients were given four clinical scenarios that described a woman with metastatic breast cancer who was stated to have a life expectancy of 18 months. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimental therapy) and were consistent with common clinical situations. Patients were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month, and 1 week. RESULTS Quality of life at the time of interview, previous chemotherapy treatment, and degree of difficulty of previous treatments did not predict patient preferences. The greater the toxicity potential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-risk treatment for as little as 1 month of added life expectancy. Between 34% and 82% of patients would prefer different therapies for a 6-month addition to life expectancy, whereas almost all patients would accept treatment for a 5-year increase in length of survival. Younger patients were more willing to assume the risks of treatment for a small increase in life expectancy. Of note, between 54% and 78% of patients would elect to start the different treatments even without symptoms related to metastatic disease. Moreover, 76% of patients would prefer standard treatment or an experimental agent to reduce symptoms or pain, even if such treatment did not prolong life. Additionally, only 10% of patients would allow randomization to a clinical trial comparing high-dose with standard chemotherapy. Participation in the study was not distressing to most patients. CONCLUSION Patients showed clear preferences for specific treatments for metastatic disease when given hypothetical scenarios. There was a wide range of patient preferences for treatment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival.

Prospective assessment of chemotherapy-induced neurotoxicity in breast cancer (HOR 02) and questionnaire survey of physicians’ perspectives

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6619-6619
Author(s):  
K. Kuroi ◽  
K. Shimozuma ◽  
Y. Ohashi ◽  
A. Takeuchi ◽  
T. Aranishi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Questionnaire Survey ◽  
Metastatic Breast ◽  
Phase Iii ◽  
Current Evidence ◽  
Average Response Rate ◽  
Prospective Assessment ◽  
Patients At Risk ◽  
Valid Instrument

6619 Background: Physician-based instruments (e.g., NCI-CTC) are widely used to assess chemotherapy-induced peripheral neuropathy (CIPN). However, current evidence suggests that physician-based assessments under-report the incidence and severity of CIPN. To overcome this limitation, a patient-based questionnaire, patient neurotoxicity questionnaire (PNQ) was developed, and a phase III randomized adjuvant trial of breast cancer (N-SAS BC 02; AC followed by PAC/DOC vs. PAC/DOC alone) has demonstrated that PNQ is reliable and sensitive and responsive instrument to assess CIPN (Shimozuma et al., SABCS 2004; #6037). We prospectively evaluated the reliability and sensitivity of PNQ in advanced or metastatic breast cancer treated by weekly administration of paclitaxel. Moreover, a questionnaire survey was conducted on physician perspectives regarding the assessment of CPIN in Japan. Methods: CIPN and QOL were prospectively assessed in thirty-five patients with advanced or metastatic breast cancer who received weekly paclitaxel (80–100 mg/m2/w). PNQ and FACT-Ntx subscale were compared to NCI-CTC. Assessments were conducted at baseline, 8 wk, 16 wk after starting treatments. A questionnaire was sent to physician who participated in N-SAS BC 02 to clarify their perspectives regarding the CPIN. Results: Average response rate of the instruments was 89%. Sensory PNQ scores correlated with sensory FACT-Ntx scores (r=0.51), and NCI-CTC scores (r=0.58). NCI-CTC scores mainly distributed between 0 and 1, while PNQ scores widely distributed. Follow-up study revealed that sensory CIPN assessed by PNQ appeared to be sensitive as compared to NCI-CTC. In clinician survey, 47 out of 61 physicians (77%) responded, and majority of them considered neurosensory symptoms as diagnostic hallmark for CIPN. However, for the justification for treatment delay, dose modification, or treatment cessation, most laid weight on functional impairment in patients with CIPN. Most (80%) rated PNQ is helpful in management of patients at risk for CIPN. Conclusions: This study confirmed that physicians tended to underestimate CIPN, and PNQ was a more reliable and valid instrument to assess CIPN with high acceptability in physicians. [Table: see text]

scholarly journals Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer

2018 ◽  
Vol 129 ◽  
pp. 54-66 ◽  
Author(s):  
Ilaria Trestini ◽  
Luisa Carbognin ◽  
Sara Monteverdi ◽  
Sara Zanelli ◽  
Alessandro De Toma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Metastatic Breast Cancer ◽  
Clinical Implication ◽  
Early Stage ◽  
Metastatic Breast

scholarly journals Eribulin: clinical review and new perspective in advanced breast cancer

2021 ◽  
Author(s):  
Arvind Gadekar
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Large Scale ◽  
Safety Data ◽  
Metastatic Breast ◽  
Clinical Findings ◽  
Cytotoxic Agents ◽  
Phase Iii ◽  
Microtubule Inhibitor ◽  
Specific Patient

Eribulin is a unique microtubule inhibitor with mitotic and nonmitotic mechanisms of action. Eribulin has substantial activity in patients with pretreated (anthracycline and a taxane) advanced or metastatic breast cancer was confirmed by large-scale phase III clinical trials. We review recent pharmacological and clinical findings of eribulin use in metastatic breast cancer, particularly highlighting eribulin in difficult-to-treat and aggressive disease and safety data in specific patient populations. Furthermore, recent advancements and potential future directions for its clinical usage in our understanding are discussed. Ongoing studies of eribulin in combination with immunotherapies and established cytotoxic agents may facilitate to shape the future landscape in the treatment of breast cancer.

scholarly journals It doesn’t make sense, but we do: framing disease in an online metastatic breast cancer support community

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ariane B. Anderson
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Late Stage ◽  
Illness Perceptions ◽  
Early Stage ◽  
Metastatic Breast ◽  
Peer To Peer ◽  
Online Discussions ◽  
Breast Cancer Patients ◽  
Cancer Support

Using Weick’s sensemaking as a conceptual framework to investigate online discussions between members of a Facebook group of metastatic breast cancer patients, and using thematic analysis to examine textual threads between group members, this research examines participants’ framing of cancer survivorship. Participants in peer-to-peer disease support groups, which are not led by medical experts, communicate differently among themselves in order to cope with chronic and terminal illness. Perceptions of survivorship of late stage patients versus early stage patients differ for a variety of reasons, with late stage patients understanding their illness trajectory more often as chronic and declining. This analysis identified three properties of sensemaking used by members to manage their disease: identity, retrospective, and enactment. Results indicate that peer-to-peer online support group communication engenders distinct framing logics that members draw upon for group support as they manage a chronic and terminal disease.

Efficacy and safety of first-line bevacizumab combined with paclitaxel in 220 patients with metastatic breast cancer: The Hungarian AVAREG observational study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12022-e12022
Author(s):  
Magdolna Dank ◽  
Laszlo Budi ◽  
Laszlo Landherr ◽  
Bela Piko ◽  
Laszlo Mangel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Safety Data ◽  
Real Life ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Efficacy And Safety ◽  
First Line ◽  
Er Positive ◽  
Oncology Practice

e12022^ Background: First-line bevacizumab (Bev) combined with paclitaxel (Pac) significantly improves progression-free survival (PFS) and response rate vs. Pac alone in HER2-negative metastatic breast cancer (mBC), as shown in the E2100 study. The efficacy and safety of first-line Bev-Pac treatment was investigated in a non-interventional study in routine oncology practice in Hungary. Methods: Patients (pts) who had received no prior chemotherapy for mBC received Bev–Pac combination therapy according to the EU label. The primary endpoint was PFS. Efficacy and safety were documented until progression, death, or Bev discontinuation, whichever occurred first. Subgroup analyses of efficacy were conducted in pts with triple-negative mBC (TNBC). Results: Efficacy and safety data were available from 220 treated pts. Baseline characteristics were: median age 56 years (range 30–79; 13% ≥65 years; 4% ≥70 years); 18%/23% stage III/IV disease at first diagnosis; 36% disease-free interval ≤2 years; 46%/44%/30% bone/lung/liver metastases; 75%/21%/3% ECOG status 0/1/2; 45% ER positive; 48% TNBC. The Bev schedule was 10 mg/kg q2w (median 14 q2w Bev cycles) in 51% of pts and 15 mg/kg q3w (median 10 q3w Bev cycles) in 49%. The median duration of follow-up was 12.2 months (range: 0.9–36.5). Median PFS was 9.3 months (95% CI 7.8–10.8) in the total population (events in 63%), 8.3 months (95% CI 7.8–8.8) in the TNBC subgroup, and 13.3 months (95% CI 10.9–15.6) in the non-TNBC subgroup (log-rank p=0.001 between the TNBC and non-TNBC subgroups). Median time to treatment failure was 7.0 months (95% CI 6.1–8.0). The 1-year survival rate was 68%. Median OS was not reached. Adverse events (AEs) occurred in 36% of pts, and were classified as serious in 8% (20 events). The most common AEs (any grade) were hypertension, neuropathy, proteinuria, and anemia. There were three deaths, from pulmonary embolism, venous thromboembolism, and cardiomyopathy, on Bev therapy. No new safety signals were seen. Conclusions: These data in the real-life setting reconfirm that first-line Bev–Pac therapy is an effective and well-tolerated treatment option for mBC pts, with notable activity in pts with TNBC. Clinical trial information: NCT01777932.

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