surviving chemotherapy for breast cancer

While grade 3–4 neutropenia occurred more frequently with docetaxel, other acute adverse events were similar in the two treatment arms. Contact your local chapter of the American Cancer Society for more information. Tumor angiogenesis and novel antiangiogenic strategies. In addition, the development of targeted biologic agents active against MBC, such as trastuzumab and bevacizumab, has demonstrated great potential for enhancing the effects of chemotherapy and producing meaningful survival improvements. There is no single standard of care for patients with MBC, as treatment plans require an individualized approach based on multiple factors. The median time to disease progression and median overall survival time were statistically significantly longer in the docetaxel arm (Table 2). I forgot about being a cancer patient and all the guests assumed I was the “fun” chick in the wigs. The combination of doxorubicin (50 mg/m2) and docetaxel (75 mg/m2) (AD) was compared with doxorubicin (60 mg/m2) and cyclophosphamide (500 mg/m2) (AC) as first‐line chemotherapy in 429 women with MBC [40]. Subgroup analyses showed that docetaxel produced substantially higher response rates than did doxorubicin in patients with negative prognostic factors, including visceral metastases and resistance to prior chemotherapy. There are a number of agents with established single‐agent activity, with the anthracyclines and taxanes generally considered the most active. Kim Tronic knows this all too well.At 36, she was diagnosed with stage 3 ovarian cancer and her care team recommended a treatment plan that included 18 weeks of chemo. Late effects of cancer treatment can come from any of the main types of cancer treatment: chemotherapy, hormone therapy, radiation, surgery, targeted therapy and immunotherapy. Disease-free survival is how long a woman lives without the breast cancer coming back. Overall survival is how long a woman lives, with or without the breast cancer … Implications of Anthracycline‐Resistant and Taxane‐Resistant Metastatic Breast Cancer and New Therapeutic Options. In addition, there is a small but growing number of randomized clinical trials reporting statistically significant survival improvements in women with MBC [14, 15, 22–30]. A phase II study of gemcitabine plus paclitaxel in patients with metastatic breast cancer and prior anthracycline treatment. Preliminary results from a phase III trial of paclitaxel with or without bevacizumab as first‐line treatment of 715 patients with MBC appear very promising [16]. Again, crossover was not mandated, and the potential impact of sequential therapy on survival outcomes has not been evaluated. Relative survival rates. Measures of Outcome in Metastatic Breast Cancer: Insights From a Real‐World Scenario. A subsequent survival analysis suggested that patients who received capecitabine following docetaxel had a longer median survival time than patients receiving other poststudy chemotherapy agents [36]. The role of the taxanes, antimetabolites, and biologics in extending survival in MBC is discussed. If progression or disease recurrence takes place in a relatively short time (i.e., <12 months), the use of different classes of classes of agents is generally preferable. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who … Neutropenia, febrile neutropenia, and infections occurred more frequently with doxorubicin. The median overall survival time with the combination was 18.5 months, 2.7 months higher than that seen with single‐agent paclitaxel. Clinical outcomes with taxane combination regimens in anthracycline‐pretreated breast cancer patients have been very encouraging, with significant survival benefits observed in two phase III trials [24–26]. For those who did have chemotherapy, the rate was 1.5 percent higher. A prognostic 10‐lncRNA expression signature for predicting the risk of tumour recurrence in breast cancer patients. In addition, capecitabine (Xeloda®; Hoffmann‐La Roche Inc., Nutley, NJ, http://www.rocheusa.com), gemcitabine (Gemzar®; Eli Lilly and Company, Indianapolis, http://www.lilly.com), and vinorelbine (Navelbine®; GlaxoSmithKline, Philadelphia, http://www.gsk.com) have also demonstrated substantial activity in the metastatic setting [3]. Breast cancer survival data in this table are from people diagnosed on or after January 1, 2018 who did not get neoadjuvant therapy. Seven phase III trials have evaluated a taxane in combination with an anthracycline versus a standard anthracycline‐based combination in patients with MBC (Table 5) [28, 29, 40–44]. Among those diagnosed in stage 1, the five-year survival … Preclinical data indicate that breast cancer invasiveness and metastasis is dependent on the establishment of new blood vessels, and VEGF is a potent stimulator of angiogenesis [48]. In addition, patients who received trastuzumab had a significant improvement in global QoL scores (p < .05). In a phase III trial comparing AP (60/175 mg/m2) with AC (60/600 mg/m2) as first‐line chemotherapy in 265 anthracycline‐naïve patients, no differences in response or survival outcomes were seen between treatment arms [42]. Depending on the individual patient and specific treatment goals, either can be appropriate. Two important phase III trials have evaluated the addition of trastuzumab to chemotherapy in women with HER‐2–overexpressing MBC [14, 15]. After completion of therapy, fatigue scores were significantly better than baseline scores in patients receiving chemotherapy and trastuzumab (p < .05). Surgery, in addition to treatments like chemotherapy and radiation therapy, may increase the length of survival for metastatic breast cancer patients, according to a new study. Gastrointestinal adverse events and hand‐foot syndrome were more common with combination therapy, whereas febrile neutropenia, sepsis, arthralgia, and myalgia were more common with single‐agent docetaxel. Angiogenesis is essential for cancer growth and metastasis. The use of combination therapy versus monotherapy or sequential single agents remains a controversial issue [9]. With respect to QoL measures, in general, treatment regimens for MBC do not appear to impair overall QoL. A common feature in many of these trials has been the use of a taxane, and more recently, a taxane combined with an antimetabolite. Overall, toxicities were consistent with those expected, with the combination producing more grade 3–4 neutropenia than single‐agent docetaxel. A QoL analysis found no difference between treatment groups, and overall QoL was maintained. Stage I and II breast cancers. A prognostic eight‐gene expression signature for patients with breast cancer receiving adjuvant chemotherapy. At the time of disease progression, patients were to be crossed over to the alternate treatment. The incidences of grade 3–4 neutropenia were similar for both arms, although febrile neutropenia occurred more frequently with AD. Asia-Pacific Journal of Clinical Oncology. Capecitabine in Combination with Novel Targeted Agents in the Management of Metastatic Breast Cancer: Underlying Rationale and Results of Clinical Trials, https://doi.org/10.1634/theoncologist.10-90003-20. That study permitted limited prior doxorubicin exposure in the adjuvant setting. A QoL analysis was conducted, and though interpretation of the results was limited, there were no apparent differences in QoL between treatment groups. The results of a phase III trial evaluating single‐agent docetaxel (100 mg/m2) with or without trastuzumab as first‐line therapy for MBC have also shown a significant benefit from the addition of trastuzumab (Table 6) [15]. Capecitabine, a novel, oral fluoropyrimidine carbamate, has been extensively evaluated in anthracycline‐ and taxane‐pretreated MBC. Sphingosine 1–phosphate signaling induces SNAI2 expression to promote cell invasion in breast cancer cells. The second study compared single‐agent docetaxel (100mg/m2) with single‐agent paclitaxel (175mg/m2) in 449 patients with MBC who had previously received first‐line metastatic therapy with an anthracycline‐based regimen or had disease progression within 12 months of completing anthracycline‐based adjuvant or neoadjuvant therapy [23]. Mature results of a large multicenter phase II trail, Phase II study of capecitabine (Xeloda®) in patients with advanced breast cancer (ABC), previously treated with anthracyclines and taxanes, Combination versus sequential single‐agent therapy in metastatic breast cancer, Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front‐line chemotherapy for metastatic breast cancer: an intergroup trial (E1193), A randomized phase II study of combination, alternating and sequential regimens of doxorubicin and docetaxel as first‐line chemotherapy for women with metastatic breast cancer, Concomitant versus sequential administration of epirubicin and paclitaxel as first‐line therapy in meta‐static breast carcinoma: results for the Gruppo Oncologico Nord Ovest randomized trial, Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first‐line treatment of metastatic breast cancer: a Spanish Breast Cancer Research Group (GEICAM‐9903) phase III study, Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2, Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2‐positive meta‐static breast cancer administered as first‐line treatment: the M77001 study group, E2100: a randomized phase III trial of paclitaxel versus paclitaxel plus bevacizumab as first‐line therapy for locally recurrent or metastatic breast cancer, Presented at the 41st Annual Meeting of the American Society of Clinical Oncology, Long‐term follow‐up of patients with complete remission following combination chemotherapy for metastatic breast cancer, Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women, Response to chemotherapy is a major parameter influencing long‐term survival of metastatic breast cancer patients, Objective response to chemotherapy as a potential surrogate end point of survival in metastatic breast cancer patients, The impact of new chemotherapeutic and hormonal agents on the survival of women with metastatic breast cancer in a population based cohort, Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with meta‐static breast cancer progressing despite previous anthracycline‐containing chemotherapy. The overall response rate and time to disease progression were significantly greater for patients randomized to doxorubicin than for those given paclitaxel, but there was no statistical difference in overall survival time between groups (Table 4). The overall response rate, median time to disease progression, and median overall survival time were all statistically superior with the combination, with an absolute improvement in median overall survival time of 3 months. In comparison with sequential methotrexate and 5‐fluorouracil, docetaxel produced a significantly higher overall response rate and longer time to disease progression, but median overall survival was not different between the two treatment groups. Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF). Response rates of 15%–26% were demonstrated, with a median survival time of approximately 1 year. These include single‐agent and combination regimens, including inpatients with anthracycline‐ and/or taxane‐pretreated disease. The absolute difference in median survival time in this study was impressive, at 8.5 months, 37% higher than with docetaxel alone. Grade 3–4 toxicities, including fatigue, alopecia, and infection, were more frequent with docetaxel. Prior adjuvant chemotherapy was permitted. Although retrospective, these data suggest that sequential administration of docetaxel and capecitabine may also have favorable survival outcomes. Have fun. There was no planned crossover design, and further treatment at the time of disease progression was at the investigator's discretion. Weighted gene correlation network analysis identifies RSAD2, HERC5, and CCL8 as prognostic candidates for breast cancer. In comparison with the combination of 5‐fluorouracil and vinorelbine, no significant differences in response or survival outcomes were seen between study arms, though overall tolerability was greater with docetaxel. Survival Impact of Integrative Cancer Care in Advanced Metastatic Breast Cancer. Two additional phase III trials compared single‐agent docetaxel with either sequential methotrexate and 5‐fluorouracil or 5‐fluorouracil in combination with vinorelbine (Table 2) [33, 34]. Breast cancer survivor shares her chemotherapy tips for patients who need chemotherapy. Prior nonanthracycline‐based adjuvant chemotherapy was allowed. The overall response rate, median time to disease progression, and median overall survival time were all statistically superior with the combination than with single‐agent therapy. It is interesting to note that, among all these trials, in no case has a docetaxel‐based regimen been inferior with respect to overall survival outcome. Journal of Cellular and Molecular Medicine. FIVE weddings to go to! Paclitaxel was also directly compared with albumin‐bound paclitaxel (ABI‐007) in 460 patients with MBC (who had not received prior paclitaxel or docetaxel for MBC) in a randomized phase III trial [35]. 304 Study Group, Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer, Superior survival with capecitabine plus docetaxel combination therapy in anthracycline‐pre‐treated patients with advanced breast cancer: phase III trial results, Global phase III study of gemcitabine plus paclitaxel (T) as frontline therapy for metastatic breast cancer (MBC): first report of overall survival, Gemcitabine plus paclitaxel (GT) versus paclitaxel (T) as first‐line treatment for anthracycline pre‐treated metastatic breast cancer (MBC): interim results of a global phase III study, Initial paclitaxel improves outcome compared with CMFP combination chemotherapy as front‐line therapy in untreated metastatic breast cancer, Phase II study comparing AT to FAC as first line chemotherapy in patients with MBC, Doxorubicin and paclitaxel versus fluorouracil, doxorubicin, and cyclophosphamide as first‐line therapy for women with metastatic breast cancer: final results of a randomized phase III multicenter trial, First‐line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicenter, randomized, phase III study, Docetaxel: an update of its use in advanced breast cancer, Docetaxel compared with sequential methotrexate and 5‐fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomised phase III study with crossover on progression by the Scandinavian Breast Group, Docetaxel vs 5‐fluorouracil plus vinorelbine in metastatic breast cancer after anthracycline therapy failure, Superior efficacy of albumin‐bound paclitaxel, ABI‐007, compared with polyethylated castor oil‐based paclitaxel in women with metastatic breast cancer: results of a phase III trial, Survival benefit with capecitabine/docetaxel versus docetaxel alone: analysis of therapy in a randomized phase III trial, Gemcitabine plus paclitaxel (GT) versus paclitaxel (T) as first‐line treatment for anthracycline pre‐treated metastatic breast cancer (MBC): quality of life (QoL) and pain palliation results from the global phase III study, Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer, Paclitaxel versus doxorubicin as first‐line single‐agent chemotherapy for metastatic breast cancer: a European Organization for Research and Treatment of Cancer randomized study with cross‐over, Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first‐line chemotherapy for metastatic breast cancer: results of a randomized, multicenter phase III trial, Final results of the phase III randomized trial comparing docetaxel (T) doxorubicin (A) and cyclophosphamide (C) to FAC as first line chemotherapy (CT) for patients (pts) with metastatic breast cancer (MBC), Doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first‐line chemotherapy in metastatic breast cancer: the European Organization for Research and Treatment of Cancer 10961 multicenter phase III trial, UKCCCR trial of epirubicin and cyclophosphamide (EC) versus epirubicin and Taxol (ET) in the first‐line treatment of women with metastatic breast cancer (MBC), Multicentric phase III study in first line treatment of advanced metastatic breast cancer (ABC). The overall response rate and median time to disease progression were statistically superior with AD than with AC, though the median overall survival time did not differ between the two treatment arms (Table 5). Demonstrating this point are the results of Intergroup trial E1193, in which patients were randomized to receive either paclitaxel (Taxol®; Bristol‐Myers Squibb, Princeton, NJ, http://www.bms.com), docetaxel (Taxotere®; Aventis Pharmaceuticals Inc., Bridgewater, NJ, http://www.aventispharma‐us.com), or a combination of the two as first‐line treatment of MBC [10]. In addition to the E1193 trial, two randomized phase III trials have evaluated a single‐agent taxane therapy versus single‐agent doxorubicin for patients with MBC without prior anthracycline exposure [38, 39]. Both the trastuzumab–taxane randomized trials demonstrated that overall survival is optimized in HER‐2–positive MBC patients by beginning trastuzumab along with the first chemotherapy regimen given for MBC rather than giving trastuzumab following first‐line chemotherapy. Taxane‐based therapy, therefore, is often a primary option for patients who have previously been treated with anthracycline‐based therapy and present with disease progression or recurrence. Though numerous randomized clinical trials have shown improvements in overall response rates, few have found clear survival benefits. Find an outlet. Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com. Combinations of traditional chemotherapeutics with targeted biologic agents, such as trastuzumab (Herceptin®; Genentech, Inc., South San Francisco, CA, http://www.gene.com) and more recently bevacizumab (Avastin®; Genentech, Inc.), appear to present a new dimension. 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