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He Y, Liu P, Zhang Y, Deng X, Meng W, Wei M, Yang T, Wang Z, Qiu M. Low-dose capecitabine adjuvant chemotherapy in elderly stage II/III colorectal cancer patients (LC-ACEC): study protocol for a randomized controlled trial. Trials 2015; 16:238. [PMID: 26021722 PMCID: PMC4465020 DOI: 10.1186/s13063-015-0753-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/12/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Over half of the patients were diagnosed with colorectal cancer after 70 years of age. The choice of the most suitable chemotherapy strategy is the major challenge for elderly patients. Previous trials indicated that elderly patients with stage II/III colorectal cancer obtained no significant benefits from oxaliplatin-based adjuvant chemotherapy. Therefore, single-agent oral capecitabine is regarded as an effective alternative with retained efficacy and improved flexibility. However, the optimal dose of capecitabine for elderly patients remains controversial. Recent studies have adopted a low-dose strategy (1,000 mg/m(2)) for elderly patients, but the long-term efficacy of this strategy has not been identified so far. Thus, we designed this trial to investigate non-inferiority of the lower-dose strategy of capecitabine compared with the approved-dose strategy for adjuvant chemotherapy of elderly patients with stage II/III colorectal cancer. METHODS LC-ACEC (Low-dose Capecitabine Adjuvant Chemotherapy for Elderly Patients With Stage II/III Colorectal Cancer) is a prospective, randomized, open-label, non-inferiority phase III clinical trial including 926 eligible patients. Patients will be randomly assigned to receive a capecitabine adjuvant chemotherapy strategy of lower dose (1,000 mg/m(2) twice daily on days 1 to 14 of every 21 days) or approved dose (1,250 mg/m(2) twice daily on days 1 to 14 of every 21 days). The primary outcome is 3-year disease-free survival. Secondary outcomes include 3-year overall survival, toxic and side effects during treatment, completion rate, and quality of life. DISCUSSION This is the first randomized trial to evaluate the efficacy and safety of a low-dose strategy of capecitabine in adjuvant chemotherapy of elderly patients with stage II/III colorectal cancer, and the results are believed to provide new evidence on the treatment of elderly patients with colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02316535 (Dec. 12, 2014).
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Affiliation(s)
- Yazhou He
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China. .,West China School of Medicine, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Ping Liu
- Colorectal Cancer Clinical Research Center, The Third Affiliated Hospital of Kunming Medical University, # 519 Kunzhou Road, Kunming, Yunnan, 650118, PR. China.
| | - Yuanchuan Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Wenjian Meng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Tinghan Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
| | - Meng Qiu
- Department of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, # 37 Guo Xue Alley, Chengdu, Sichuan, 610041, PR. China.
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Kaufman PA, Awada A, Twelves C, Yelle L, Perez EA, Velikova G, Olivo MS, He Y, Dutcus CE, Cortes J. Phase III open-label randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 2015; 33:594-601. [PMID: 25605862 PMCID: PMC4463422 DOI: 10.1200/jco.2013.52.4892] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose This phase III randomized trial (ClinicalTrials.gov identifier: NCT00337103) compared eribulin with capecitabine in patients with locally advanced or metastatic breast cancer (MBC). Patients and Methods Women with MBC who had received prior anthracycline- and taxane-based therapy were randomly assigned to receive eribulin or capecitabine as their first-, second-, or third-line chemotherapy for advanced/metastatic disease. Stratification factors were human epidermal growth factor receptor-2 (HER2) status and geographic region. Coprimary end points were overall survival (OS) and progression-free survival (PFS). Results Median OS times for eribulin (n = 554) and capecitabine (n = 548) were 15.9 and 14.5 months, respectively (hazard ratio [HR], 0.88; 95% CI, 0.77 to 1.00; P = .056). Median PFS times for eribulin and capecitabine were 4.1 and 4.2 months, respectively (HR, 1.08; 95% CI, 0.93 to 1.25; P = .30). Objective response rates were 11.0% for eribulin and 11.5% for capecitabine. Global health status and overall quality-of-life scores over time were similar in the treatment arms. Both treatments had manageable safety profiles consistent with their known adverse effects; most adverse events were grade 1 or 2. Conclusion In this phase III study, eribulin was not shown to be superior to capecitabine with regard to OS or PFS.
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Affiliation(s)
- Peter A Kaufman
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain.
| | - Ahmad Awada
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Chris Twelves
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Louise Yelle
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Edith A Perez
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Galina Velikova
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Martin S Olivo
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Yi He
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Corina E Dutcus
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Javier Cortes
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
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Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging 2015; 10:157-74. [PMID: 25609933 PMCID: PMC4293298 DOI: 10.2147/cia.s50670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Bertrand Ripamonti
- Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, France
| | - Amandine Bruyas
- Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | | | - Gilles Freyer
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | - Marc Bonnefoy
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
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Tew WP, Muss HB, Kimmick GG, Von Gruenigen VE, Lichtman SM. Breast and ovarian cancer in the older woman. J Clin Oncol 2014; 32:2553-61. [PMID: 25071129 DOI: 10.1200/jco.2014.55.3073] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.
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Campone M, Yang H, Faust E, Kageleiry A, Signorovitch JE, Zhang J, Gao H. Cost of adverse events during treatment with everolimus plus exemestane or single-agent chemotherapy in patients with advanced breast cancer in Western Europe. J Med Econ 2014; 17:837-45. [PMID: 25164472 DOI: 10.3111/13696998.2014.959589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Treatment options for recurrent or progressive hormone receptor-positive (HR+) advanced breast cancer include chemotherapy and everolimus plus exemestane (EVE + EXE). This study estimates the costs of managing adverse events (AEs) during EVE + EXE therapy and single-agent chemotherapy in Western Europe. METHODS An economic model was developed to estimate the per patient cost of managing grade 3/4 AEs for patients who were treated with EVE + EXE or chemotherapies. AE rates for patients receiving EVE + EXE were collected from the phase III BOLERO-2 trial. AE rates for single-agent chemotherapy, capecitabine, docetaxel, or doxorubicin were collected from published clinical trial data. AEs with at least 2% prevalence for any of the treatments were included in the model. A literature search was conducted to obtain costs of managing each AE, which were then averaged across Western European countries (when available). Per patient costs for managing AEs among patients receiving different therapies were reported in 2012 euros (€). RESULTS The EVE + EXE combination had the lowest average per patient cost of managing AEs (€730) compared to all chemotherapies during the first year of treatment (doxorubicin: €1230; capecitabine: €1721; docetaxel: €2390). The most costly adverse event among all patients treated with EVE + EXE was anemia (on average €152 per patient). The most costly adverse event among all patients treated with capecitabine, docetaxel, or doxorubicin was lymphocytopenia (€861 per patient), neutropenia (€821 per patient), and leukopenia (€382 per patient), respectively. CONCLUSIONS The current model estimates that AE management during the treatment of HR+ advanced breast cancer will cost one-half to one-third less for EVE + EXE patients than for chemotherapy patients. The consideration of AE costs could have important implications in the context of healthcare spending for advanced breast cancer treatment.
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Affiliation(s)
- Mario Campone
- Centre René Gauducheau, Service Oncologie Médicale , Nantes Saint-Herblain , France
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Swallow E, Zhang J, Thomason D, Tan RD, Kageleiry A, Signorovitch J. Real-world patterns of endocrine therapy for metastatic hormone-receptor-positive (HR+)/human epidermal growth factor receptor-2-negative (HER2-) breast cancer patients in the United States: 2002-2012. Curr Med Res Opin 2014; 30:1537-45. [PMID: 24669852 DOI: 10.1185/03007995.2014.908829] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Clinical guidelines recommend that patients with HR+/HER2- metastatic breast cancer (mBC), the most prevalent mBC subtype, receive three lines of endocrine therapy (ET) prior to transitioning to chemotherapy (CT) in the absence of need for rapid response, symptomatic visceral disease, or suspected endocrine resistance. Little is known about real-world ET treatment patterns among HR+/HER2- mBC patients. RESEARCH DESIGN AND METHODS Post-menopausal women with HR+/HER2- mBC were identified in the MarketScan databases (2002Q3-2012Q2). Patients were classified as receiving either ET or CT as their first therapy post-mBC diagnosis. Those receiving ET were studied further and stratified into three subgroups based on which of the following events occurred first: transition to CT, discontinuation of ET (90 days without evidence of ET), or end of data or insurance eligibility. MAIN OUTCOME MEASURES Mean numbers of lines of ET and median durations of each line were summarized for the overall sample and subgroups. RESULTS Among a total of 19,120 HR+/HER2- mBC patients, 11,545 (60%) initiated an ET; median follow-up time for these patients was 17 months. Seventy-four percent did not receive a second ET. The average patient received 1.36 lines of ET. Among patients with 2+ lines of ET, the duration of each subsequent line was significantly shorter than the previous line. RESULTS were similar in all subgroups. LIMITATIONS Clinical characteristics and reasons for treatment choices are unavailable in claims data. CONCLUSIONS Fewer than two thirds of patients initiated treatment for HR+/HER2- mBC with ET. Among those who did, most received only one line of ET before discontinuation or transition to CT. Patients who received multiple lines of ET experienced shorter durations of therapy with each line. Real-world treatment with ET falls short of the targets recommended by guidelines, representing unmet need for treatment options that improve the effectiveness of endocrine therapy.
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A retrospective study evaluating a fixed low dose capecitabine monotherapy in women with HER-2 negative metastatic breast cancer. Breast Cancer Res Treat 2014; 146:7-14. [PMID: 24899084 DOI: 10.1007/s10549-014-3003-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
To determine if a low fixed dosing strategy of capecitabine would produce comparable clinical activity with less adverse toxicities compared to published data with higher doses in the setting of metastatic breast cancer (mBC). We retrospectively analyzed patients treated with a low fixed dose of capecitabine (CAPE-L) at 1,000 mg twice daily for 14 days every 21 days. Outcomes included clinical benefit rate (CBR), overall response rates (ORR), time to progression (TTP), and overall survival (OS). A historical comparison group of mBC patients treated on 12 prior trials at the package-insert dose of capecitabine (n = 1,949) was utilized. Eighty-six patients were analyzed in our cohort. Positive hormone receptor status (79.1 vs. 50.6 %), and capecitabine as first-line chemotherapy (44.2 vs. 16.5 %) were more frequent in our cohort relative to the historical comparison. The median starting dose in our cohort was 633.5 mg/m(2). The CBR was similar between the CAPE-L and the standard dose cohorts (55.8 vs. 49.5 %), as was ORR (24.3 vs. 24 %), and median TTP (7 mo, 95 % CI 5.5-8.5 vs. 5.1 mo, 95 % CI 4.5-5.7). Median OS was longer in our cohort (24 mo, 95 % CI 16.8-31.2) than the historic standard dose cohort (12.1 mo, 95 % CI 9.6-14.4), a difference that was likely explained by the higher proportion of patients in the CAPE-L cohort who received capecitabine as first-line chemotherapy and who had hormone receptor positive disease. As expected, adverse events were less frequent with CAPE-L. We found that CAPE-L, which translates into a dose of 600-650 mg/m(2), appeared to have good clinical efficacy and acceptable toxicity.
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Campana LG, Galuppo S, Valpione S, Brunello A, Ghiotto C, Ongaro A, Rossi CR. Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations. J Cancer Res Clin Oncol 2014; 140:1557-65. [PMID: 24793549 DOI: 10.1007/s00432-014-1691-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/19/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients. METHODS Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70 years (n = 27) and those ≥70 years (n = 28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance. RESULTS Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (range 6-53). Overall, CR rate was 40 % and was significantly higher in elderly patients (57 vs. 26 %, P = .023) and in patients with better performance status (PS = 0-1, 53 vs. PS = 2, 21 %, P = .048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93 % among elderly and young patients, respectively; P = .061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30 %, P = .075), but discontinued treatment more frequently due to impaired performance status (P = .002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1 %) and 8/28 (28.6 %) elderly patients at 4 and 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration. CONCLUSIONS Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection.
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Affiliation(s)
- Luca G Campana
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata, 64, 35128, Padua, Italy,
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Smorenburg CH, de Groot SM, van Leeuwen-Stok AE, Hamaker ME, Wymenga AN, de Graaf H, de Jongh FE, Braun JJ, Los M, Maartense E, van Tinteren H, Nortier JWR, Seynaeve C. A randomized phase III study comparing pegylated liposomal doxorubicin with capecitabine as first-line chemotherapy in elderly patients with metastatic breast cancer: results of the OMEGA study of the Dutch Breast Cancer Research Group BOOG. Ann Oncol 2014; 25:599-605. [PMID: 24504445 PMCID: PMC4433520 DOI: 10.1093/annonc/mdt588] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prospective data on chemotherapy for elderly patients with metastatic breast cancer (MBC) remain scarce. We compared the efficacy and safety of first-line chemotherapy with pegylated liposomal doxorubicin (PLD) versus capecitabine in MBC patients aged ≥65 years in a multicentre, phase III trial. PATIENTS AND METHODS Patients were randomized to six cycles of PLD (45 mg/m(2) every 4 weeks) or eight cycles of capecitabine (1000 mg/m(2) twice daily, day 1-14 every 3 weeks). RESULTS The study enrolled 78 of the planned 154 patients and was closed prematurely due to slow accrual and supply problems of PLD. Many included patients were aged ≥75 years (54%) and vulnerable (≥1 geriatric condition: 71%). The median dose intensity was 85% for PLD and 84% for capecitabine, respectively. In both arms, the majority of patients completed at least 12 weeks of treatment (PLD 73%; capecitabine 74%). After a median follow-up of 39 months, 77 patients had progressed and 62 patients had died of MBC. Median progression-free survival was 5.6 versus 7.7 months (P = 0.11) for PLD and capecitabine, respectively. Median overall survival was 13.8 months for PLD and 16.8 months for capecitabine (P = 0.59). Both treatments were feasible, grade 3 toxicities consisting of fatigue (both arms: 13%), hand-foot syndrome (PLD: 10%; capecitabine: 16%), stomatitis (PLD: 10%; capecitabine: 3%), exanthema (PLD: 5%) and diarrhoea (PLD: 3%; capecitabine: 5%). Only 1 of 10 patients aged ≥80 years completed chemotherapy, while 3 and 6 patients discontinued treatment due to toxicity or progressive disease, respectively. CONCLUSION Both PLD and capecitabine demonstrated comparable efficacy and acceptable tolerance as first-line single-agent chemotherapy in elderly patients with MBC, even in vulnerable patients or patients aged ≥75 years. However, patients aged ≥80 years were unlikely to complete chemotherapy successfully. CLINICAL TRIAL NUMBERS EudraCT 2006-002046-10; ISRCTN 11114726; CKTO 2006-09; BOOG 2006-02.
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Affiliation(s)
- C H Smorenburg
- Department of Internal Medicine, Medical Center Alkmaar, Alkmaar.
| | - S M de Groot
- Comprehensive Cancer Center the Netherlands, Amsterdam
| | | | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht
| | - A N Wymenga
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede
| | - H de Graaf
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden
| | - F E de Jongh
- Department of Internal Medicine, Ikazia Hospital, Rotterdam
| | - J J Braun
- Department of Internal Medicine, Vlietland Hospital, Schiedam
| | - M Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein
| | - E Maartense
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft
| | - H van Tinteren
- Biometrics Department, Netherlands Cancer Institute, Amsterdam
| | - J W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, Leiden
| | - C Seynaeve
- Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Cortes-Funes H, Ghanem I. Safety and efficacy of moderate-dose capecitabine as first-line therapy in metastatic breast cancer. Expert Rev Anticancer Ther 2014; 11:165-8. [DOI: 10.1586/era.10.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Freedman RA, Muss HB. Managing metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the older patient. J Geriatr Oncol 2014; 5:2-7. [DOI: 10.1016/j.jgo.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
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Hansra DM, Silva O, Mehta A, Ahn E. Patient with Metastatic Breast Cancer Achieves Stable Disease for 5 Years on Graviola and Xeloda after Progressing on Multiple Lines of Therapy. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/abcr.2014.33012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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63
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Luque M, Arranz F, Cueva JF, de Juan A, García-Teijido P, Calvo L, Peláez I, García-Palomo A, García-Mata J, Antolín S, García-Estévez L, Fernández Y. Breast cancer management in the elderly. Clin Transl Oncol 2013; 16:351-61. [PMID: 24085574 DOI: 10.1007/s12094-013-1113-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/15/2013] [Indexed: 01/02/2023]
Abstract
The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment.
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Affiliation(s)
- M Luque
- Medical Oncology Department, Hospital Universitario Central de Asturias, C/Julian Clavería s/n, 33006, Oviedo, Spain,
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Schwartzberg LS, Wang G, Somer BG, Blakely LJ, Wheeler BM, Walker MS, Stepanski EJ, Houts AC. Phase II trial of fulvestrant with metronomic capecitabine for postmenopausal women with hormone receptor-positive, HER2-negative metastatic breast cancer. Clin Breast Cancer 2013; 14:13-9. [PMID: 24268206 DOI: 10.1016/j.clbc.2013.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/17/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this phase II study, we explored efficacy and toxicity of combined endocrine and low-dose metronomic chemotherapy therapy consisting of fulvestrant and capecitabine in estrogen and/or progesterone receptor-positive, HER2-negative MBC. PATIENTS AND METHODS Patients with ≤ 1 previous hormonal treatment in the metastatic setting received an injection fulvestrant loading dose 500 mg on day 1, 250 mg on days 15 and 29 followed by 250 mg every 28 days along with continuous oral capecitabine in divided doses. The total fixed daily dose of capecitabine was either 1500 mg or 2000 mg, depending on the patient's weight (< 80 kg vs. ≥ 80 kg). Primary end points were PFS and TTP. Toxicity was assessed by continuous evaluations of treatment-emergent adverse events (AEs) and changes from baseline in laboratory values. RESULTS Forty-one women, with a mean age of 64.5 years, were enrolled. Patients completed a median of 11 monthly treatment cycles. Median PFS was 14.98 months (95% confidence interval [CI], 7.26-upper limit [UL] not estimated) and median TTP was 26.94 months (95% CI, 7.26-UL not estimated). Median overall survival was 28.65 months (95% CI, 23.95-UL not estimated). Treatment was well tolerated with < 10% Grade 3 palmar-plantar erythrodysesthesia. Overall, the most frequent AEs were palmar-plantar erythrodysesthesia, fatigue, and nausea. CONCLUSION Fulvestrant with metronomic capecitabine demonstrates substantial activity in hormone receptor-positive MBC and is well tolerated. Combined chemoendocrine approaches should be further explored considering the low toxicity of the combination with meaningful TTP.
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Falandry C, Brain E, Bonnefoy M, Mefti F, Jovenin N, Rigal O, Guillem O, El Kouri C, Uwer L, Abadie-Lacourtoisie S, Cretin J, Jacquin JP, Paraiso D, Freyer G. Impact of geriatric risk factors on pegylated liposomal doxorubicin tolerance and efficacy in elderly metastatic breast cancer patients: final results of the DOGMES multicentre GINECO trial. Eur J Cancer 2013; 49:2806-14. [PMID: 23735702 DOI: 10.1016/j.ejca.2013.04.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/01/2013] [Accepted: 04/27/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metastatic breast cancer chemotherapy in the elderly is considered effective in carefully selected patients, but there is little data regarding its effect in vulnerable patients. METHODS We evaluated tumour response (primary endpoint), feasibility and outcomes after six courses of an adapted dose of pegylated liposomal doxorubicin (PLD) (40 mg/m(2) every 28 days) as first-line chemotherapy for hormone-resistant MBC. RESULTS Of 60 patients >70 years (median 77 years), 15% had performance status ≥2 and 73% had visceral metastases. Geriatric assessment included: ≥2 comorbidities, 42%; ≥1 deficiency in Activities of Daily Living (ADL), 10% and Instrumental ADL (IADL), 82%; living in residential homes, 12%; albumin <35 g/L, 17%; body mass index (BMI) <21, 20%; depression, 17%; and lymphocytes ≤1 × 10(3)/mm(3), 27%. Complete response, partial response and stable disease were observed in 5%, 15% and 60%, respectively, but only 48% completed six cycles. Treatment discontinuations were mostly due to disease progression (18%) and non-haematological (NH) toxicities (22%). Eight patients died during treatment (three possibly related to PLD), and 15 had unplanned hospital admissions. Exploratory analyses to identify geriatric covariates associated with treatment outcomes revealed severe haematological toxicities significantly correlated with lymphocytes ≤1 × 10(3)/mm(3). NH toxicities correlated with age ≥80 years and living in residential homes. Progression-free survival (median 6.1 months) decreased with age, deficiency in IADL, cardiac dysfunction and living in residential homes. Overall survival (median 15.7 months) also decreased with living in residential homes. CONCLUSION Despite manageable haematological toxicities and expected response rates, PLD feasibility was poor in unselected elderly patients.
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Affiliation(s)
- C Falandry
- Department of Geriatric Medicine, Centre Hospitalier Lyon-Sud, Pierre Bénite, Université Lyon 1, Lyon, France.
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Rudek MA, Connolly RM, Hoskins JM, Garrett-Mayer E, Jeter SC, Armstrong DK, Fetting JH, Stearns V, Wright LA, Zhao M, Watkins SP, McLeod HL, Davidson NE, Wolff AC. Fixed-dose capecitabine is feasible: results from a pharmacokinetic and pharmacogenetic study in metastatic breast cancer. Breast Cancer Res Treat 2013; 139:135-43. [PMID: 23588952 DOI: 10.1007/s10549-013-2516-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/01/2013] [Indexed: 12/27/2022]
Abstract
The pro-drug capecitabine is approved for treatment of anthracycline- and paclitaxel-resistant metastatic breast cancer. However, toxicity and large interpatient pharmacokinetic variability occur despite body surface area (BSA)-dosing. We hypothesized that a fixed-dose schedule would simplify dosing and provide an effective and safe alternative to BSA-based dosing. We conducted an open label, single-arm, two-stage study of oral capecitabine with fixed starting dose (3,000 mg total daily dose in two divided doses × 14 days q21 days) in patients with metastatic breast cancer. We correlated pharmacodynamic endpoints [e.g., efficacy (response) per RECIST and toxicity], adherence and pharmacokinetics/pharmacogenetics. Sample size of 45 patients was required to detect a 25 % response rate from null response rate of 10 % using a Simon two-stage design. Twenty-six patients were enrolled in the first-stage and 21 were evaluable after a median of four cycles of capecitabine. Two thirds of patients received either the same dose or a dose 500 mg lower than what would have been administered with a commonly used 2,000 mg/m(2) BSA-dosing schedule. Eight patients had stable disease but progressed after a median of seven cycles. Despite a clinical benefit rate of 19 %, no RECIST responses were observed following the first stage and the study was closed. Dose-reductions were required for grade 2 hand-foot syndrome (28 %) and vomiting (5 %). Adherence was similar when using both patient-reported and Medication Event Monitoring System methods. High interpatient variability was observed for capecitabine and metabolite pharmacokinetics, but was not attributed to observed pharmacogenetic or BSA differences. Single agent activity of capecitabine was modest in our patients with estrogen receptor-positive or -negative metastatic breast cancer and comparable to recent studies. BSA was not the main source of pharmacokinetic variability. Fixed-dose capecitabine is feasible, and simplifies dosing.
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Affiliation(s)
- Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans Street, CRB1-1M52, Baltimore, MD 21231, USA.
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Andreopoulou E, Sparano JA. Chemotherapy in Patients with Anthracycline- and Taxane-Pretreated Metastatic Breast Cancer: An Overview. CURRENT BREAST CANCER REPORTS 2013; 5:42-50. [PMID: 23440080 PMCID: PMC3579672 DOI: 10.1007/s12609-012-0097-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Anthracyclines and taxanes are cytotoxic agents that are commonly used for the treatment of breast cancer, including in the adjuvant, neoadjuvant, and metastatic setting. Each drug class of is associated with cumulative and potentially irreversible toxicity, including cardiomyopathy (anthracyclines) and neuropathy (taxanes). This may either limit the duration of therapy for advanced disease, or prevent retreatment for recurrence if previously used as component of adjuvant or neoadjuvant therapy. Several classes of cytotoxic agents have been evaluated in patients with anthracycline and taxane-pretreated metastatic breast cancer (MBC), including other antitubulins (vinorelbine, ixabepilone, eribulin), antimetabolites (capecitabine, gemcitabine), topoisomerase I inhibitors (irinotecan), platinum analogues (cisplatin, carboplatin), and liposomal doxorubicin preparations. No trials have shown an overall survival advantage for combination chemotherapy in this setting, indicating that single cytotoxic agents should usually be used, expect perhaps in patients with rapidly progressive disease and/or high tumor burden.
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Affiliation(s)
- Eleni Andreopoulou
- Assistant Professor Medicine, Albert Einstein College of Medicine, Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, 1825 Eastchester Road, 2South Rm 60, Bronx, New York 10461, Phone 718-904-2900, Fax 718-904-2890
| | - Joseph A. Sparano
- Professor Medicine of Medicine Women’s Health, Albert Einstein College of Medicine, Department of Oncology, Chief, Section of Breast Medical Oncology, Montefiore Medical Center, 1825 Eastchester Road, 2South, Rm 48, Bronx, New York 10461, Phone 718-903-2555, Fax 718-904-2892
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68
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Aromatase inhibitors in the treatment of elderly women with metastatic breast cancer. Breast 2013; 22:142-149. [PMID: 23321585 DOI: 10.1016/j.breast.2012.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/26/2012] [Accepted: 12/17/2012] [Indexed: 11/22/2022] Open
Abstract
The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.
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Daniele G, Gallo M, Piccirillo MC, Giordano P, D'Alessio A, Del Giudice A, La Porta ML, Perrone F, Normanno N, De Luca A. Pharmacokinetic evaluation of capecitabine in breast cancer. Expert Opin Drug Metab Toxicol 2013; 9:225-35. [PMID: 23301520 DOI: 10.1517/17425255.2013.759939] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Capecitabine , an oral prodrug of 5-fluorouracil (5-FU), is adsorbed in its intact form through the intestine and metabolized to 5-FU in tumour cells. In metastatic breast cancer (MBC), capecitabine is an effective and well-tolerated therapeutic option both in monotherapy and in combination with chemotherapeutic or molecular-targeted agents. AREAS COVERED We summarized data on pharmacokinetics and pharmacodynamics of capecitabine. We also produced a general review of the most relevant clinical studies of capecitabine in MBC. A literature search was performed using PubMed database including selected articles published in English language up to October 2012. EXPERT OPINION The unique pharmacodynamic/pharmacokinetic features represent the bases of the reduced toxicity and the activity of capecitabine in several tumours. Although during the past 10 years there has been an increasing use of this drug in MBC both as single agent and in combination, encouraging results of well tolerated and active combinations with novel agents will lead to a more extensive and protracted use of capecitabine. In view of this, some aspects should be further clarified such as the optimal starting dose and the introduction of alternative schedules of treatment.
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70
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Aprile G, Ferrari L, Fontanella C, Puglisi F. Bevacizumab in older patients with advanced colorectal or breast cancer. Crit Rev Oncol Hematol 2012; 87:41-54. [PMID: 23265855 DOI: 10.1016/j.critrevonc.2012.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/28/2012] [Accepted: 11/20/2012] [Indexed: 12/18/2022] Open
Abstract
The incidence of colorectal and breast cancer is growing among the 550 million living people aged 65 or older. Bevacizumab was the first anti-angiogenic agent approved for the treatment of the advanced phase of these cancers. Although older chronological age still hampers the use of modern treatments, there is a widespread awareness that chronological and physiological (i.e. functional) ages may largely differ, and that seniority itself should not be a stringent limit for the introduction of anti-angiogenics. However, the use of bevacizumab in the general older population is questionable. There is limited evidence of a favorable risk-to-benefit ratio, with efficacy data deriving from clinical trials that selected only elderly patients in rather good health. While summarizing the recent advances, this review highlights specific clinical features characterizing those older patients who may benefit the most from receiving bevacizumab.
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71
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Capecitabine and oxaliplatin in combination as first- or second-line therapy for metastatic breast cancer: a Wisconsin Oncology Network trial. Cancer Chemother Pharmacol 2012; 71:613-8. [PMID: 23228989 DOI: 10.1007/s00280-012-2044-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Several cytotoxic chemotherapy regimens are active against metastatic breast cancer; however, benefits are modest and overall prognosis remains limited. For anthracycline and taxane-pretreated metastatic breast cancer, there remains a relative paucity of therapies with significant activity. This Phase II study evaluated the combination of capecitabine and oxaliplatin (XELOX) among patients with metastatic breast cancer being treated in the first- or second-line setting. METHODS Patients received oxaliplatin 85 mg/m(2) on days 1 and 15, and capecitabine 1,500 mg/m(2) twice daily on days 1-7 and 15-21 of a 28-day cycle. Patients were treated until progression or intolerable toxicity. The primary objective was to estimate the objective response rate by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria with tumor assessments every 8 weeks. RESULTS Ten patients were treated of which 3 had received prior neurotoxic therapy in the metastatic setting. There were no confirmed complete responses, 5 patients had partial response, 4 patients had stable disease for at least 24 weeks, and one patient was unevaluable. Median time to progression (TTP) was 10.4 months (95% lower confidence bound [LCB]: 5.75 months), median progression-free survival (PFS) was 14.2 months (95% LCB: 6.14 months), and median overall survival (OS) was 19 months (95% LCB: 12.8 months). Multiple patients experienced pain syndromes and unusual neuropathies. Other common toxicities included fatigue, diarrhea, and nausea. CONCLUSIONS XELOX is a promising regimen for anthracycline-pretreated metastatic breast cancer although careful patient selection is indicated and alternate dosing schedules should be explored to minimize neurologic morbidity.
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72
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Ayoub JPM, Verma S, Verma S. Advances in the management of metastatic breast cancer: options beyond first-line chemotherapy. ACTA ACUST UNITED AC 2012; 19:91-105. [PMID: 22514495 DOI: 10.3747/co.19.1024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article provides an overview of recent advances in chemotherapy that may be used for the treatment of patients with locally advanced or metastatic breast cancer (MBC). Key phase ii and iii trial data for eribulin mesylate, ixabepilone, and nab-paclitaxel, published since 2006, are discussed on the basis of recency, depth, and quality.Eribulin mesylate is the first monotherapy to significantly increase overall survival in patients with pretreated MBC, but nab-paclitaxel offers a novel and safer mode of delivery in comparison with standard taxanes. By contrast, the use of ixabepilone will be limited for now, until the associated neurotoxicity can be better managed. Alongside a brief overview of the other major chemotherapies currently in use, we have aimed to provide a Canadian context for how these novel agents may be integrated into clinical practice.
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Affiliation(s)
- J P M Ayoub
- Hematology-Oncology Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC
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73
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Aapro M, Wildiers H. Triple-negative breast cancer in the older population. Ann Oncol 2012; 23 Suppl 6:vi52-5. [DOI: 10.1093/annonc/mds189] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Jolly T, Williams GR, Jones E, Muss HB. Treatment of Metastatic Breast Cancer in Women Aged 65 Years and Older. WOMENS HEALTH 2012; 8:455-69; quiz 470-1. [DOI: 10.2217/whe.12.18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Breast cancer is a disease of aging and the incidence of breast cancer increases dramatically with increasing age. In spite of major advances in prevention, screening and treatment approximately 40,000 Americans still die of metastatic breast cancer every year – the majority being women aged 65 years and older. Metastatic breast cancer remains incurable regardless of age and the goals of treatment are to reduce symptoms when present and to provide the patient with the best quality of life for as long as possible. Cornerstones of treatment to control metastases include endocrine therapy, chemotherapy and radiation therapy. Supportive care that includes psychosocial support and treatment of pain is also a key component of management. This review focuses on the issues related to the care of older women with metastatic breast cancer.
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Affiliation(s)
- Trevor Jolly
- Division of Hematology & Oncology, Department of Medicine, University of North Carolina – Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC 27599-7305, USA
| | - Grant R Williams
- 5003 Old Clinic Building, Campus Box 7550, Chapel Hill, NC 27599-7550, USA
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina – Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC 27599, USA
| | - Hyman B Muss
- University of North Carolina – Chapel Hill, Lineberger Comprehensive Cancer Center, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC 27599, USA
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Gogineni K, DeMichele A. Current approaches to the management of Her2-negative metastatic breast cancer. Breast Cancer Res 2012; 14:205. [PMID: 22429313 PMCID: PMC3446361 DOI: 10.1186/bcr3064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
While metastatic breast cancer (MBC) remains incurable, a vast array of active therapeutic agents has provided the opportunity for long-term disease control while maintaining quality of life and physical function. Optimal management of MBC balances a multitude of factors, including a woman's performance status, social support, symptoms, disease burden, prior therapies, and surrogates for tumor biology. Choosing the most appropriate initial therapy and subsequent sequence of treatments demands flexibility as goals and patient preferences may change. Knowledge of the estrogen receptor (ER), progesterone receptor (PR), and Her2 receptor status of the metastatic tumor has become critical to determining the optimal treatment strategy in the metastatic setting as targeted therapeutic approaches are developed. Patients with ER+ or PR+ breast cancer or both have a wide array of hormonal therapy options that can forestall the use of cytotoxic therapies, although rapidly progressive phenotypes and the emergence of resistance may ultimately lead to the need for chemotherapy in this setting. So-called 'triple-negative' breast cancer - lacking ER, PR, and Her2 overexpression - remains a major challenge. These tumors have an aggressive phenotype, and clear targets for therapy have not yet been established. Chemotherapy remains the mainstay of treatment in this group, but biologically based clinical trials of new agents are critical to developing a more effective set of therapies for this patient population.
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Affiliation(s)
- Keerthi Gogineni
- Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, West Pavilion, 3rd Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Wong H, Tang YF, Yao TJ, Chiu J, Leung R, Chan P, Cheung TT, Chan AC, Pang RW, Poon R, Fan ST, Yau T. The outcomes and safety of single-agent sorafenib in the treatment of elderly patients with advanced hepatocellular carcinoma (HCC). Oncologist 2011; 16:1721-8. [PMID: 22135121 DOI: 10.1634/theoncologist.2011-0192] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND With the aging population, hepatocellular carcinoma (HCC) in the elderly represents a significant health burden. We aimed to evaluate and compare the efficacy and tolerability of single-agent sorafenib in treating elderly patients with advanced HCC versus the younger population. METHODS We retrospectively analyzed a consecutive cohort of advanced HCC patients with Child-Pugh A or B liver function and an Eastern Cooperative Oncology Group performance status score of 0-2 treated with sorafenib. The patients were categorized into older (age ≥70 years) and younger (age <70 years) groups. Treatment outcomes and related adverse events (AEs) were compared. RESULTS In total, 172 patients, 35 in the older (median age, 73 years) and 137 in the younger (median age, 55 years) group, were analyzed. The median progression-free survival time was similar in the older and younger groups (2.99 months versus 3.09 months; p = .275), as was the overall survival time (5.32 months versus 5.16 months; p = .310). Grade 3 or 4 AEs were observed in 68.6% of older and 62.7% of younger patients (p = .560), with neutropenia (11.4% versus 0.7%; p = .007), malaise (11.4% versus 2.2%; p = .033), and mucositis (5.7% versus 0.0%; p = .041) being more frequently reported in the elderly cohort. CONCLUSIONS The survival benefits and overall treatment-related AEs of sorafenib are comparable in elderly and younger advanced HCC patients. Nevertheless, more vigilant monitoring in the elderly is warranted because they are more susceptible to develop neutropenia, malaise, and mucositis.
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Affiliation(s)
- Hilda Wong
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Chang HJ, Lee KW, Kim JH, Bang SM, Kim YJ, Kim DW, Kang SB, Lee JS. Adjuvant capecitabine chemotherapy using a tailored-dose strategy in elderly patients with colon cancer. Ann Oncol 2011; 23:911-8. [PMID: 21821549 DOI: 10.1093/annonc/mdr329] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study was conducted to analyze the feasibility of adjuvant capecitabine therapy using a tailored-dose escalation strategy in elderly patients with colon cancer (CC). METHODS CC patients (≥ 70 years of age) who received adjuvant capecitabine were enrolled. The starting dosage of capecitabine was 2000 mg/m(2)/day (days 1-14, every 3 weeks). On the second cycle, the dosage was escalated to 2500 mg/m(2)/day if the patient tolerated the first cycle. Dose intensity (DI), toxicity, and the change in quality of life (QoL) were evaluated. RESULTS Of 82 patients enrolled, 67 completed eight cycles. Dose escalation to 2500 mg/m(2)/day was possible in 56 patients, and this dosage was maintained in 24 patients until the completion of chemotherapy (eight cycles). Forty-one patients completed therapy with a DI ≥ 1333 mg/m(2)/day [relative dose intensity (RDI) ≥ 80%]. Toxic effects were tolerable and the QoL was not compromised during treatment. Creatinine clearance < 50 ml/min and Charlson-Age comorbidity index ≥ 8 were related to a reduced capecitabine dosage (RDI < 80%). CONCLUSIONS A tailored-dose escalation strategy was feasible in elderly CC patients receiving adjuvant capecitabine chemotherapy. Decreased renal function and an increased number of comorbidities were independently predictive of reduced administration of the capecitabine dose.
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Affiliation(s)
- H J Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Infante JR, Jones SF, Bendell JC, Greco FA, Yardley DA, Lane CM, Spigel DR, Hainsworth JD, Burris HA. A drug interaction study evaluating the pharmacokinetics and toxicity of sorafenib in combination with capecitabine. Cancer Chemother Pharmacol 2011; 69:137-44. [PMID: 21626051 DOI: 10.1007/s00280-011-1674-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/06/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To address tolerability and a possible pharmacologic interaction of capecitabine with sorafenib. METHODS Patients with advanced solid tumors (ECOG PS 0-1) were included. Cohort A received capecitabine 750 mg/m(2) BID and Cohort B received capecitabine 1,000 mg/m(2) BID, both for 14 days of a 21-day cycle. Steady-state PK was obtained for capecitabine alone, sorafenib alone, and in combination. Cohort C explored an alternate schedule of 7-day on/7-day off flat dose capecitabine 1,000 mg BID with continuous dosing of sorafenib 400 mg BID. RESULTS A total of 32 patients were enrolled between February 08 and April 09. Hand-foot skin reaction (HFSR) was the primary toxicity with 16 (50%) of the 32 patients experiencing grade 3 events (75% occurring during cycles 1-2). Grade 3 HFSR defined the maximum tolerated dose (MTD) of Cohort C at 1,000 mg BID flat dose of capecitabine. Other grade 3/4 toxicities were rare (diarrhea 6%, mucositis 3%, and fatigue 3%). Capecitabine did not change the C (max) or AUC((0-12)) of sorafenib. Co-administration of sorafenib with capecitabine 750 mg/m(2) (n = 6 patients) increased capecitabine AUC((0-12)) 15% and produced no change in the 5FU AUC((0-12)). At the capecitabine 1,000 mg/m(2) dose level (n = 12 pts), there was a 16% increase in capecitabine AUC((0-12)) and an 8% increase in 5FU AUC((0-12)). However, these trends were not statistically significant. CONCLUSIONS Co-administration of sorafenib resulted in a mild increase in capecitabine AUC, although not statistically significant. Capecitabine did not affect the exposure of sorafenib. The rate of grade 3 HFSR is concerning and limits the feasibility of prolonged dosing of sorafenib with capecitabine 1,000 mg/m(2) on the 21-day schedule.
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Affiliation(s)
- Jeffrey R Infante
- Sarah Cannon Research Institute, 3322 West End Avenue, Suite 900, Nashville, TN 37203, USA.
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79
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Di Bartolomeo M, Pietrantonio F, Martinetti A, Buzzoni R, Gevorgyan A, Bajetta E. Role of the antiangiogenic agent bevacizumab in the treatment of elderly patients with metastatic colorectal cancer. Drugs Aging 2011; 28:83-91. [PMID: 21155618 DOI: 10.2165/11584710-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Although major progress has been achieved in the treatment of metastatic colorectal cancer with the employment of biological antiangiogenic agents, several questions remain open for discussion regarding the use of this therapy in elderly patients with metastatic colorectal cancer. In Western countries, the total number of elderly patients with colorectal cancer is expected to increase in the future. As adverse physical or socioeconomic conditions are more common in the elderly, an assessment of the patient's suitability for this therapy should be performed before a treatment decision is made. Most patients in clinical trials of the antiangiogenic drug bevacizumab were aged <65 years and thus the efficacy and tolerability of this agent in older patients has been less well explored. However, this article shows that older and younger patients with metastatic colorectal cancer appeared to derive similar survival benefit from bevacizumab treatment. Elderly patients were also found to have significant prolongation of median progression-free survival with the addition of bevacizumab to their treatment, with a similar magnitude of improvement in this outcome being observed in younger and older patients. It should be emphasized that the patients included in the studies discussed in this article were eligible for clinical trials and therefore may not be representative of a more general elderly population. Careful selection of patients and monitoring of treatment effects are required to optimize use of the antiangiogenic agent bevacizumab in older patients.
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80
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Debled M, Bellera C, Donamaria C, Soubeyran P. Chemotherapy treatment for older women with metastatic breast cancer: what is the evidence? Cancer Treat Rev 2011; 37:590-8. [PMID: 21592672 DOI: 10.1016/j.ctrv.2011.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/13/2011] [Accepted: 04/18/2011] [Indexed: 11/16/2022]
Abstract
While the over-representation of the elderly in the breast cancer population is projected to dramatically increase within the next two decades, data on chemotherapy for elderly patients with metastatic breast carcinoma (MBC) remain very limited. The aim of the present study is to investigate whether elderly patients included in clinical studies for MBC are representative of the population seen during usual clinical practice. Firstly, a review of the literature was performed identifying 39 publications about chemotherapy for MBC focusing on elderly patients and we examined patient characteristics in each of these publications. Comparison of the age distribution of patients included in these studies with that of a large cohort of consecutive MBC patients aged 65years who received chemotherapy in our institution over the last ten years (n=573) indicated that trials tend to include relatively younger patients. Furthermore, criteria to assess external validity of the results are seldom reported. Possible ways to improve the applicability of results such as increasing the minimum age for inclusion and the use of CGA are proposed.
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Affiliation(s)
- Marc Debled
- Department of Medical Oncology, Institut Bergonié, South-West Comprehensive Cancer Center, Bordeaux Cedex, France.
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81
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Caronia D, Martin M, Sastre J, de la Torre J, García-Sáenz JA, Alonso MR, Moreno LT, Pita G, Díaz-Rubio E, Benítez J, González-Neira A. A Polymorphism in the Cytidine Deaminase Promoter Predicts Severe Capecitabine-Induced Hand-Foot Syndrome. Clin Cancer Res 2011; 17:2006-13. [DOI: 10.1158/1078-0432.ccr-10-1741] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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82
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Spazzapan S, Crivellari D, Bedard P, Lombardi D, Miolo G, Scalone S, Veronesi A. Therapeutic management of breast cancer in the elderly. Expert Opin Pharmacother 2011; 12:945-60. [DOI: 10.1517/14656566.2011.540570] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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83
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Bedard PL, Bernard-Marty C, Raimondi C, Cardoso F. The role of capecitabine in the management of breast cancer in elderly patients. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Comen EA, Fornier MN. Algorithms for the treatment of patients with metastatic breast cancer and prior exposure to taxanes and anthracyclines. Clin Breast Cancer 2010; 10 Suppl 2:S7-19. [PMID: 20805067 DOI: 10.3816/cbc.2010.s.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At present, metastatic breast cancer (MBC) remains an incurable disease, with the goals of care aimed at maximizing the patient's duration and quality of life. Treatment options for a patient with MBC have become more efficacious and numerous. In addition to endocrine and chemotherapy agents, a number of targeted agents, including trastuzumab and bevacizumab, are available. The option to use novel agents combined with a multitude of standard chemotherapies has further enhanced the landscape of therapeutic options. As such, specific regimens must be evaluated within the framework of the individual patient, answering such questions as whether to treat with sequential single agents or combination regimens as well as which agents to use and in what sequence. The concept of personalized care is even more apparent in the setting of MBC, where the goal of palliation is intrinsically more nuanced than that of curative intent. This review will broadly assess the evidence for current treatment options with attention to varying clinical scenarios. Ultimately, delivering quality of care necessitates balancing an understanding of evidence-based data with sensitive attention to quality-of-life goals.
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Affiliation(s)
- Elizabeth A Comen
- Department of Medicine, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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85
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Kaufmann M, Maass N, Costa S, Schneeweiß A, Loibl S, Sütterlin M, Schrader I, Gerber B, Bauer W, Wiest W, Tomé O, Distelrath A, Hagen V, Kleine-Tebbe A, Ruckhaeberle E, Mehta K, von Minckwitz G. First-line therapy with moderate dose capecitabine in metastatic breast cancer is safe and active: Results of the MONICA trial. Eur J Cancer 2010; 46:3184-91. [DOI: 10.1016/j.ejca.2010.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/05/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
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Debled M, Madranges N, Mertens C, Durand M, Brouste V, Brain E, Mauriac L. First-line chemotherapy for metastatic breast cancer in patients ≥75 years: a retrospective single-centre analysis. Crit Rev Oncol Hematol 2010; 80:171-9. [PMID: 21036058 DOI: 10.1016/j.critrevonc.2010.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 09/02/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022] Open
Abstract
Data on chemotherapy for elderly patients with metastatic breast carcinoma (MBC) are limited. We performed a 7-year retrospective analysis of MBC patients at our institution receiving first-line chemotherapy aged ≥75 years. Of 117 patients, 103 received monotherapy (67 capecitabine, 29 vinorelbine, 5 docetaxel, 2 liposomal doxorubicin) and 14 received polychemotherapy (12 anthracycline-based, 2 vinorelbine-gemcitabine). Chemotherapy demonstrated acceptable tolerability. Median progression-free survival (PFS) and overall survival (OS) from initiation of chemotherapy were 6.2 months and 13.8 months, respectively. At 2 years, 25% of patients were alive; however, 25% died within 3 months of beginning chemotherapy. Independent prognostic factors for longer PFS were good performance status, absence of visceral disease and capecitabine treatment. Good performance status and lack of visceral disease were also significant for OS. These results suggest that palliative chemotherapy should not be systematically excluded in this setting, but should be carefully discussed as it appears to be feasible with apparent benefit in selected patients.
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Affiliation(s)
- Marc Debled
- Institut Bergonié, South-West Comprehensive Cancer Center, Bordeaux, France.
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87
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Yun JA, Kim HC, Son HS, Kim HR, Yun HR, Cho YB, Yun SH, Lee WY, Chun HK. Oncologic outcome after cessation or dose reduction of capecitabine in patients with colon cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:287-92. [PMID: 21152231 PMCID: PMC2998011 DOI: 10.3393/jksc.2010.26.4.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/27/2010] [Indexed: 01/03/2023]
Abstract
Purpose Oral capecitabine has been used as adjuvant therapy for colorectal cancer patients since the 1990s. Patient-initiated cessation or reduced use of capecitabine occurs widely for various reasons, yet the consequences of these actions are unclear. The present study sought to clarify treatment outcomes in such patients. Methods The study included 173 patients who had been diagnosed with stage II or III colon cancer according to the pathologic report after radical surgery at Samsung Medical Center from May 2005 to June 2007 and who had received capecitabine as adjuvant therapy. The patients were divided into groups according to whether the dose was reduced (I, dose maintenance; II, dose reduction) or stopped (A, cycle completion; B, cycle cessation). Recurrence and disease-free survival rates between the two groups each were analyzed. Results Of the 173 patients, 128 (74.6%) experienced complications, most frequently hand-foot syndrome (n = 114). Reduction (n = 35) or cessation (n = 18) of medication was most commonly due to complications. Concerning reduced dosage, both groups displayed no statistically significant differences in recurrence rate and 3-year disease-free survival rate. Concerning discontinued medication use, the cycle completion group showed an improved recurrence rate (P = 0.048) and 3-year disease-free survival rate (P = 0.028). Conclusion The results demonstrate that maintaining compliance with capecitabine as an adjuvant treatment for colon cancer to preventing complications positively affects patient prognosis.
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Affiliation(s)
- Jung-A Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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88
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Müller V, Thomssen C, Schmidt M, Glados M, Jackisch C, Heilmann V, Hinke A, Lehnert A, Borowicz H, Möbus V. Final results of a phase I/II pilot study of capecitabine with or without vinorelbine after sequential dose-dense epirubicin and paclitaxel in high-risk early breast cancer. BMC Cancer 2010; 10:430. [PMID: 20712886 PMCID: PMC2928799 DOI: 10.1186/1471-2407-10-430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 08/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of the non-cross-resistant chemotherapeutic agents capecitabine and vinorelbine into an intensified dose-dense sequential anthracycline- and taxane-containing regimen in high-risk early breast cancer (EBC) could improve efficacy, but this combination was not examined in this context so far. METHODS Patients with stage II/IIIA EBC (four or more positive lymph nodes) received post-operative intensified dose-dense sequential epirubicin (150 mg/m(2) every 2 weeks) and paclitaxel (225 mg/m(2) every 2 weeks) with filgrastim and darbepoetin alpha, followed by capecitabine alone (dose levels 1 and 3) or with vinorelbine (dose levels 2 and 4). Capecitabine was given on days 1-14 every 21 days at 1000 or 1250 mg/m2 twice daily (dose levels 1/2 and 3/4, respectively). Vinorelbine 25 mg/m2 was given on days 1 and 8 of each 21-day course (dose levels 2 and 4). RESULTS Fifty-one patients were treated. There was one dose-limiting toxicity (DLT) at dose level 1. At dose level 2 (capecitabine and vinorelbine), five of 10 patients experienced DLTs. Therefore evaluation of vinorelbine was abandoned and dose level 3 (capecitabine monotherapy) was expanded. Hand-foot syndrome and diarrhoea were dose limiting with capecitabine 1250 mg/m2 twice daily. At 35.2 months' median follow-up, the estimated 3-year relapse-free and overall survival rates were 82% and 91%, respectively. CONCLUSIONS Administration of capecitabine monotherapy after sequential dose-dense epirubicin and paclitaxel is feasible in node-positive EBC, while the combination of capecitabine and vinorelbine as used here caused more DLTs.
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Affiliation(s)
- Volkmar Müller
- University Medical Center, Hamburg, Department of Gynecology, Martinistrasse 52, 20246 Hamburg, Germany
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Pal SK, Hurria A. Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol 2010; 28:4086-93. [PMID: 20644100 DOI: 10.1200/jco.2009.27.0579] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A theme of personalized medicine was highlighted at the 2009 Annual Meeting of the American Society of Clinical Oncology. To this end, the current review focuses on the impact of host characteristics (such as age, sex, and comorbidity) as they pertain to cancer biology, treatment efficacy, and tolerance. Increasing age is associated with complex changes in physiology, including alterations in renal and hepatic function, and decreased bone marrow reserve. These may in turn result in alterations in pharmacokinetics and toxicity related to many commonly used anticancer agents. Using tools, such as the geriatric assessment, may help to elucidate the physiologic age of the patient as opposed to the chronologic age. Increasing age is paralleled by an increase in comorbidity, and comorbidity may have independent prognostic implications and substantially impact medical decision making in the patient with cancer. Numerous biologic ties between cancer and comorbidity exist, one example being an association of diabetes with an increased risk of disease recurrence and mortality in the setting of colon cancer. Biologic features can also vary by sex; several biomarkers with either prognostic or predictive value (ie, excisionrepair cross-complementation group 1 expression, epidermal growth factor receptor mutation, or dihydropyrimidine dehydrogenase polymorphism) may differentiate efficacy or toxicity in males and females. Taken together, age, sex, and comorbidity each encompass a complex array of physiologic and molecular variations that may each aid in personalizing care for the patient with cancer.
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Affiliation(s)
- Sumanta Kumar Pal
- Experimental Therapeutics and Cancer Control and Population Sciences Program, Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA, USA
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Kotsori AA, Noble JL, Ashley S, Johnston S, Smith IE. Moderate dose capecitabine in older patients with metastatic breast cancer: a standard option for first line treatment? Breast 2010; 19:377-81. [PMID: 20392643 DOI: 10.1016/j.breast.2010.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 03/13/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022] Open
Abstract
Single agent capecitabine is effective and well tolerated in metastatic breast cancer (MBC). We have retrospectively analysed capecitabine outcome as 1st, 2nd or 3rd line chemotherapy in 89 elderly patients ≥70 years with locally advanced or MBC treated in our Unit, 55 (62%) as 1st line and 34 (38%) as 2nd or 3rd line. Starting dose was 1000 mg/m(2) twice daily, days 1-14 every 3 weeks, but 36 (41%) started on a 25% dose reduction because of frailty and 12 (13%) reduced dose after the 1st or the 2nd cycle. Overall response rate (ORR) was 45% (95% CI: 35-55%). A further 19 (21%) achieved stable disease (SD) for ≥6 months. Median time to progression (TTP) and overall survival (OS) were 30 (95% CI: 23-37) and 61 (95% CI: 44-77) weeks, respectively. The ORR for 1st line treatment was 51% compared with 35% for 2nd and 3rd line treatment (p = 0.03). No significant difference in efficacy was seen between patients receiving the full versus reduced dose. Capecitabine was well tolerated, although 35% had treatment delays and 57% required dose reduction. Grade 3-4 toxicities were hand-foot syndrome in 11%, lethargy 9% and diarrhoea 2%. Capecitabine is an effective and well-tolerated drug in elderly patients with MBC including for 1st line treatment. Dose reduction is frequently required but does not appear to affect outcome.
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Affiliation(s)
- A A Kotsori
- Breast Unit RMH and Institute of Cancer Research, Fulham Road, London, United Kingdom.
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92
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Oral combination chemotherapy with capecitabine and cyclophosphamide in patients with metastatic breast cancer: a phase II study. Anticancer Drugs 2010; 21:453-8. [DOI: 10.1097/cad.0b013e328336acb1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Steimer JL, Dahl SG, De Alwis DP, Gundert-Remy U, Karlsson MO, Martinkova J, Aarons L, Ahr HJ, Clairambault J, Freyer G, Friberg LE, Kern SE, Kopp-Schneider A, Ludwig WD, De Nicolao G, Rocchetti M, Troconiz IF. Modelling the genesis and treatment of cancer: the potential role of physiologically based pharmacodynamics. Eur J Cancer 2010; 46:21-32. [PMID: 19954965 DOI: 10.1016/j.ejca.2009.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 09/30/2009] [Accepted: 10/09/2009] [Indexed: 12/01/2022]
Abstract
Physiologically based modelling of pharmacodynamics/toxicodynamics requires an a priori knowledge on the underlying mechanisms causing toxicity or causing the disease. In the context of cancer, the objective of the expert meeting was to discuss the molecular understanding of the disease, modelling approaches used so far to describe the process, preclinical models of cancer treatment and to evaluate modelling approaches developed based on improved knowledge. Molecular events in cancerogenesis can be detected using 'omics' technology, a tool applied in experimental carcinogenesis, but also for diagnostics and prognosis. The molecular understanding forms the basis for new drugs, for example targeting protein kinases specifically expressed in cancer. At present, empirical preclinical models of tumour growth are in great use as the development of physiological models is cost and resource intensive. Although a major challenge in PKPD modelling in oncology patients is the complexity of the system, based in part on preclinical models, successful models have been constructed describing the mechanism of action and providing a tool to establish levels of biomarker associated with efficacy and assisting in defining biologically effective dose range selection for first dose in man. To follow the concentration in the tumour compartment enables to link kinetics and dynamics. In order to obtain a reliable model of tumour growth dynamics and drug effects, specific aspects of the modelling of the concentration-effect relationship in cancer treatment that need to be accounted for include: the physiological/circadian rhythms of the cell cycle; the treatment with combinations and the need to optimally choose appropriate combinations of the multiple agents to study; and the schedule dependence of the response in the clinical situation.
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95
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Zielinski C, Gralow J, Martin M. Optimising the dose of capecitabine in metastatic breast cancer: confused, clarified or confirmed? Ann Oncol 2010; 21:2145-2152. [PMID: 20332132 DOI: 10.1093/annonc/mdq069] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While 'targeted' drugs often take centre stage when considering developments in breast cancer, improved understanding, administration and use of chemotherapeutic agents also contribute to better outcomes for women with metastatic breast cancer. Moreover, these developments offer the potential for further improvements when chemotherapy and targeted agents are combined. In this article, we focus on capecitabine dosing in advanced breast cancer, review the available data and discuss the implications of this evidence on best treatment practice both for chemotherapy alone and for chemotherapy when combined with biological agents. It appears that a capecitabine starting dose of 1000 mg/m² twice daily enables treatment to be administered for longer periods, providing continuous exposure to cytotoxic therapy and thus prolonging the duration of disease control. Although no randomised data are available comparing different doses of capecitabine, the cumulative evidence supports this approach.
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Affiliation(s)
- C Zielinski
- Department of Medicine I and Clinical Division of Oncology, Medical University of Vienna, Vienna; Central European Cooperative Oncology Group (CECOG), Vienna, Austria.
| | - J Gralow
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - M Martin
- Medical Oncology Department, Hospital Clinico San Carlos, Madrid, Spain
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Yardley DA. Visceral Disease in Patients With Metastatic Breast Cancer: Efficacy and Safety of Treatment With Ixabepilone and Other Chemotherapeutic Agents. Clin Breast Cancer 2010; 10:64-73. [DOI: 10.3816/cbc.2010.n.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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97
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Ciruelos EM, Cortés J, Cortés-Funes H, Mayordomo JI, Bermejo B, Ojeda B, García E, Rodríguez CA, Muñoz M, Gómez P, Manso L, Andrés R, Lluch A, Saura C, Mendiola C, Baselga J. Gemcitabine and capecitabine in previously anthracycline-treated metastatic breast cancer: a multicenter phase II study (SOLTI 0301 trial). Ann Oncol 2009; 21:1442-1447. [PMID: 19940004 DOI: 10.1093/annonc/mdp536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND On the basis of clinical activity of capecitabine and gemcitabine for metastatic breast cancer, we carried out a multicenter phase II clinical trial on the combination of these two agents in advanced anthracycline-pretreated breast cancer patients. Main objectives were to assess its efficacy and safety profile. PATIENTS AND METHODS Seventy-six anthracycline-pretreated breast cancer patients were evaluated and were stratified according to previous treatment of advanced disease (group-1: not previously treated and group-2: previously treated). Study treatment consisted of gemcitabine 1000 mg/m(2), i.v., as 30 min-infusion, days 1 and 8 every 21 days, plus oral capecitabine 830 mg/m(2) b.i.d., days 1-14 every 21 days. RESULTS Overall response rate was 61% for group-1, 48.5% for group-2 and 55.2% for the whole population. Clinical benefit rate was 73% for group-1, 80% for patients in group-2 and 76% for all patients. Median time to progression was 13.0 months for group-1, 8.2 months for group-2 and 11.1 months for the whole population. Most frequent grade 3-4 observed toxic effects per patient were neutropenia (60%), asymptomatic liver toxicity (13.5%), asthenia (14%) and hand-foot syndrome (16%). Only one patient presented febrile neutropenia. No treatment-related deaths occurred. CONCLUSION Combination of gemcitabine and capecitabine is an active and safe regimen in anthracycline-pretreated breast cancer patients.
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Affiliation(s)
- E M Ciruelos
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid.
| | - J Cortés
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - H Cortés-Funes
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - J I Mayordomo
- Medical Oncology Division, Hospital Clínico de Zaragoza, Zaragoza
| | - B Bermejo
- Medical Oncology Division, Hospital Clínico de Valencia, Valencia
| | - B Ojeda
- Medical Oncology Division, Hospital de Sant Pau, Barcelona
| | - E García
- Medical Oncology Division, Hospital Morales Meseguer, Murcia
| | - C A Rodríguez
- Medical Oncology Division, Hospital Clínico de Salamanca, Salamanca
| | - M Muñoz
- Medical Oncology Division, Hospital Clínico de Barcelona, Barcelona, Spain
| | - P Gómez
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - L Manso
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - R Andrés
- Medical Oncology Division, Hospital Clínico de Zaragoza, Zaragoza
| | - A Lluch
- Medical Oncology Division, Hospital Clínico de Valencia, Valencia
| | - C Saura
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - C Mendiola
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - J Baselga
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
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Amari M, Ishida T, Takeda M, Ohuchi N. Capecitabine monotherapy is efficient and safe in all line settings in patients with metastatic and advanced breast cancer. Jpn J Clin Oncol 2009; 40:188-93. [PMID: 19887522 DOI: 10.1093/jjco/hyp145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Capecitabine is effective and well tolerated in patients with anthracycline- and/or taxane-pre-treated metastatic breast cancer. We compared the efficacy and safety of capecitabine monotherapy between 1st, 2nd, 3rd and > or =4th line settings for advanced and metastatic breast cancer pre-treated with/without anthracycline and taxanes. METHODS Subjects comprised 84 patients with histologically confirmed advanced or metastatic breast cancer and at least one measurable metastatic lesion. We evaluated time to disease progression (TTP), response rate (RR) and clinical benefit rate (CBR) for 1st (n = 17), 2nd (n = 28), 3rd (n = 23) and > or =4th (n = 16) line setting treatments of capecitabine monotherapy. RESULTS Median number of cycles of capecitabine monotherapy was 12 cycles in 1st line, 11 cycles in 2nd line, 9 cycles in 3rd line and 11 cycles in > or =4th line. RR and CBR were 23.5% and 58.8% in 1st line, 21.4% and 53.6% in 2nd line, 21.7% and 52.2% in 3rd line, and 18.8% and 50.0% in > or =4th line, respectively. No significant differences in TTP were seen between each line setting (P = 0.843). CONCLUSIONS Capecitabine monotherapy is effective and well tolerated in all line settings of chemotherapy in patients with metastatic or advanced breast cancer, and is suitable for outpatient therapy.
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Affiliation(s)
- Masakazu Amari
- Division of Surgical Oncology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Beslija S, Bonneterre J, Burstein H, Cocquyt V, Gnant M, Heinemann V, Jassem J, Köstler W, Krainer M, Menard S, Petit T, Petruzelka L, Possinger K, Schmid P, Stadtmauer E, Stockler M, Van Belle S, Vogel C, Wilcken N, Wiltschke C, Zielinski C, Zwierzina H. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20:1771-85. [DOI: 10.1093/annonc/mdp261] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Morris PG, McArthur HL, Hudis CA. Therapeutic options for metastatic breast cancer. Expert Opin Pharmacother 2009; 10:967-81. [PMID: 19351274 DOI: 10.1517/14656560902834961] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metastatic breast cancer (MBC) remains an incurable disease despite ongoing therapeutic advances. Recently there has been progress extending the range of available cytotoxic chemotherapy drugs and optimizing their scheduling. In addition, a greater understanding of tumor biology has led to the development of a number of targeted therapies. Several of these newer agents, such as trastuzumab, lapatinib and bevacizumab, have demonstrated activity in combination with chemotherapy and have improved the prognosis of patients with MBC. We hope that further progress elucidating the pathophysiology and biology of MBC will continue to lead to corresponding advances in treatment.
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Affiliation(s)
- Patrick G Morris
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, NY 10065, New York, USA
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