NEW YORK (Reuters Health) Apr 08 - Longer first-line chemo for metastatic breast cancer yields a significant and clinically meaningful improvement in progression-free survival, and a modest but significant improvement in overall survival, a meta-analysis indicates.
"Chemotherapy should be administered until new disease progression is detected," Dr. Alessandra Gennari, from Galliera Hospital, Genoa, Italy, wrote in an email to Reuters Health.
Giving full doses of chemotherapy until progression, however, "may not be feasible and can probably be considered an outdated approach in modern oncology," she admits.
Instead, "It is possible that patients after a few full-dose courses of chemotherapy could be switched to more tolerable chemotherapy schedules and agents: this is what sometime happens in clinical practice, but is unfortunately without evidence from clinical trials."
As reported online April 4th in the Journal of Clinical Oncology, Dr. Gennari and colleagues combed the literature for randomized controlled trials that compared shorter with longer chemotherapy durations in the first-line treatment of metastatic breast cancer. Eleven studies (including one reported only in a meeting abstract) with a total of 2,269 women met their inclusion criteria.
The number of cycles of chemotherapy in the control groups ranged from three to eight. The number of maintenance cycles ranged from a minimum of six to whatever number could be completed without disease progression or unacceptable toxicity.
A longer duration of first-line chemotherapy was associated with a 9% reduction in the risk of death (hazard ratio, 0.91; P = 0.046).
Longer as opposed to shorter chemotherapy was also associated with a 36% reduction in the hazard of progression (hazard ratio, 0.64; p < 0.001).
The benefits of extending chemotherapy appeared to be independent of the type of chemotherapy, number of cycles in the shorter arm, and concomitant endocrine therapy.
"Although we are in the era of targeted therapies, chemotherapy is, in any case, the backbone of the treatment of metastatic breast cancer," Dr. Gennari said. "It should also be considered that sooner or later all metastatic breast cancer patients will require chemotherapy administration (in some upfront, in others after failure of target therapies, endocrine, etc)."
The current meta-analysis, Dr. Gennari and colleagues say, supports a similar one performed 7 years ago. Both studies "support a policy of prolonging treatment until disease progression, in the absence of unacceptable toxicity."
In an editorial, Dr. Andrew D. Seidman of Memorial Sloan-Kettering Cancer Center in New York acknowledges that the results favor the "longer is better" approach. But "this is the point in the clinic when the art of medicine intersects with the science of medicine," he writes.
Dr. Seidman favors an individual approach, urging oncologists to have open discussions with their patients on the risks and benefits of a longer first-line chemotherapy duration or a treat-to-progression approach.
"Chemotherapy should be administered until new disease progression is detected," Dr. Alessandra Gennari, from Galliera Hospital, Genoa, Italy, wrote in an email to Reuters Health.
Giving full doses of chemotherapy until progression, however, "may not be feasible and can probably be considered an outdated approach in modern oncology," she admits.
Instead, "It is possible that patients after a few full-dose courses of chemotherapy could be switched to more tolerable chemotherapy schedules and agents: this is what sometime happens in clinical practice, but is unfortunately without evidence from clinical trials."
As reported online April 4th in the Journal of Clinical Oncology, Dr. Gennari and colleagues combed the literature for randomized controlled trials that compared shorter with longer chemotherapy durations in the first-line treatment of metastatic breast cancer. Eleven studies (including one reported only in a meeting abstract) with a total of 2,269 women met their inclusion criteria.
The number of cycles of chemotherapy in the control groups ranged from three to eight. The number of maintenance cycles ranged from a minimum of six to whatever number could be completed without disease progression or unacceptable toxicity.
A longer duration of first-line chemotherapy was associated with a 9% reduction in the risk of death (hazard ratio, 0.91; P = 0.046).
Longer as opposed to shorter chemotherapy was also associated with a 36% reduction in the hazard of progression (hazard ratio, 0.64; p < 0.001).
The benefits of extending chemotherapy appeared to be independent of the type of chemotherapy, number of cycles in the shorter arm, and concomitant endocrine therapy.
"Although we are in the era of targeted therapies, chemotherapy is, in any case, the backbone of the treatment of metastatic breast cancer," Dr. Gennari said. "It should also be considered that sooner or later all metastatic breast cancer patients will require chemotherapy administration (in some upfront, in others after failure of target therapies, endocrine, etc)."
The current meta-analysis, Dr. Gennari and colleagues say, supports a similar one performed 7 years ago. Both studies "support a policy of prolonging treatment until disease progression, in the absence of unacceptable toxicity."
In an editorial, Dr. Andrew D. Seidman of Memorial Sloan-Kettering Cancer Center in New York acknowledges that the results favor the "longer is better" approach. But "this is the point in the clinic when the art of medicine intersects with the science of medicine," he writes.
Dr. Seidman favors an individual approach, urging oncologists to have open discussions with their patients on the risks and benefits of a longer first-line chemotherapy duration or a treat-to-progression approach.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου