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Chen L, Yan X, Luo T, Tian T, He P, Zhong X. Efficacy and safety of eribulin mesylate in patients with locally advanced or metastatic breast cancer previously treated with anthracycline/taxanes. Cancer Med 2024; 13:e7295. [PMID: 38785215 PMCID: PMC11117449 DOI: 10.1002/cam4.7295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND This prospective real-world study aimed to assess the efficacy and safety of eribulin in the clinical practice against advanced breast cancer (ABC) in China. PATIENTS AND METHODS In this study, eligible patients with inoperable locally advanced or metastatic breast cancer who had experienced prior neo-/adjuvant or failed the palliative treatment with anthracycline/taxanes were included. Eribulin (1.4 mg/m2) was infused intravenously on Day 1 and Day 8 every 3 weeks until disease progression or intolerable toxicity occurred. The progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and safety of the treatment were assessed. RESULTS One hundred and thirty-four patients were enrolled. The median PFS (mPFS) was 4.3 months (95% CI: 0.3-15.4). The ORR and DCR was 32.1% and 79.1%, respectively. The mPFS of patients who received eribulin as first- or second-line treatment was significantly better than those who received eribulin as ≥3-line treatment (6.9 months [95% CI: 3.2-8.8] vs. 4.0 months [95% CI: 3.4-4.6], p = 0.006). The mPFS of patients with triple-negative, HER2-positive, and HER2(-)/HR(+) was 3.4 (95% CI: 2.7-4.1), 6.2 (95% CI: 2.3-10.1) and 5.0 months (95% CI: 4.1-5.9), respectively. HER2(+) patients had significantly longer PFS than TNBC patients (p = 0.022). Patients received combination therapy had a significantly longer mPFS than those who received eribulin monotherapy (5.0 months [95% CI 3.6-6.3] vs. 4.0 months [95% CI: 3.3-4.7] [p = 0.016]). Multivariate analysis revealed that MBC patients with a molecular typing of non-TNBC receiving eribulin as ≤2-line therapy and combination therapy had a low risk of disease progression. Neutropenia (33.58%), leukopenia (11.94%), and thrombocytopenia (4.48%) were the most common treatment-related adverse events. CONCLUSION Eribulin demonstrated effective clinical activity and a favorable tolerability profile in Chinese patients with ABC in the real-world. The efficacy and safety profile were consistent with those reported in previous randomized phase 3 trials.
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Affiliation(s)
- Lan Chen
- Department of Medical Oncology, West China HospitalSichuan UniversityChengduSichuan ProvincePeople's Republic of China
| | - Xi Yan
- Department of Medical OncologyHead and Neck Cancer Department, West China HospitalChengduSichuan ProvincePeople's Republic of China
| | - Ting Luo
- Department of Medical OncologyHead and Neck Cancer Department, West China HospitalChengduSichuan ProvincePeople's Republic of China
| | - Tinglun Tian
- Department of Medical OncologyHead and Neck Cancer Department, West China HospitalChengduSichuan ProvincePeople's Republic of China
| | - Ping He
- Department of Medical OncologyHead and Neck Cancer Department, West China HospitalChengduSichuan ProvincePeople's Republic of China
| | - Xiaorong Zhong
- Department of Medical OncologyHead and Neck Cancer Department, West China HospitalChengduSichuan ProvincePeople's Republic of China
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Tam A, Li YR, Williams T, Yoon S. Grade 5 Radiation Necrosis After Whole-Brain Radiation Therapy. Pract Radiat Oncol 2024; 14:87-92. [PMID: 38431371 DOI: 10.1016/j.prro.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 03/05/2024]
Abstract
Whole-brain radiation treatment is often considered for patients with leptomeningeal disease. There are limited reports of the development of radiation necrosis after whole-brain radiation treatment and fewer associating the presence of germline mutations with risk. We present a case report to highlight the need for consideration of radiosensitizing mutations when recommending radiation therapy.
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Affiliation(s)
- Andrew Tam
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Yun Rose Li
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California; Beckman Research Institute, City of Hope National Cancer Center, Duarte, California
| | - Terence Williams
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California; Beckman Research Institute, City of Hope National Cancer Center, Duarte, California
| | - Stephanie Yoon
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California.
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Baek SK, Jeong JH, Jung K, Ahn HK, Kim MH, Sohn J, Park IH, Ahn JS, Lee DW, Im SA, Sim SH, Lee KS, Hyun Kim J, Shim HJ, Chae Y, Koh SJ, Lee H, Lee J, Byun JH, Seol Y, Lee EM, Jee HJ, An H, Park EB, Suh YJ, Lee KE, Park YH. A nationwide real-world study for evaluation of effectiveness and safety of T-DM1 in patients with HER2-positive metastatic breast cancer in Korea (KCSG BR19-15). Ther Adv Med Oncol 2024; 16:17588359231225029. [PMID: 38288157 PMCID: PMC10823858 DOI: 10.1177/17588359231225029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose This study aimed to investigate clinical practices and factors related to the outcomes of T-DM1 use in patients with HER2-positive metastatic breast cancer (mBC). Methods We included patients with HER2-positive mBC who received T-DM1 as a palliative therapy between August 2017 and December 2018. The safety and outcomes of T-DM1, including overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), were evaluated. A Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval (CI) for mortality or progression to HER2-positive mBC. Results In total, 824 patients were enrolled during the study period. The mean age of patients was 58 years, and 516 (62.6%) patients relapsed after curative treatment. Excluding a history of endocrine therapy, 341 (41.4%) patients previously received none or first-line chemotherapy, 179 (21.7%) received second-line therapy, and 303 (36.9%) received third-or later-line chemotherapy before T-DM1 therapy. During a median follow-up of 16.8 months, the ORR was 35%, the median PFS was 6.6 months, and the median OS was not reached. The clinical factors associated with the hazard of progression were age (<65 years), poor performance status (⩾2), advanced line of palliative chemotherapy (⩾2), prior pertuzumab use, and treatment duration of palliative trastuzumab (<10 months). Common grade 3-4 adverse events were thrombocytopenia (n = 107, 13.2%), neutropenia (n = 23, 2.8%), anemia (n = 21, 2.6%), and elevated liver enzyme (n = 20, 2.5%). Hypokalemia (⩽3.0 mmol/L) and any-grade bleeding events occurred in 25 (3.1%) and 94 (22.6%) patients, respectively. Conclusion This is the first nationwide real-world study of T-DM1 use in patients with HER2-positive mBC in Korea. The effectiveness and toxicity profiles of T-DM1 in real-world practice were comparable to those in randomized trials. Moreover, patient factors and previous anti-HER2 therapy could predict the outcomes of T-DM1 therapy.
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Affiliation(s)
- Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jae-ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - KyungHae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology and Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Min Hwan Kim
- Division of Medical Oncology and Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joohyuk Sohn
- Division of Medical Oncology and Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Hae Park
- Division of Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Hematology-Oncology, Chonnam National University Medical School and Hwasun Hospital, Gwangju, Republic of Korea
| | - Yeesoo Chae
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyorak Lee
- Division of Hematology/Oncology, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jieun Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Byun
- Division of Medical Oncology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Youngmi Seol
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun Mi Lee
- Department of Internal Medicine, Kosin University Gaspel Hospital, Busan, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eun Byeol Park
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Gui X, Liang X, Li H. Effectiveness, safety, and impact on quality of life of eribulin-based therapy in heavily pretreated patients with metastatic breast cancer: A real-world analysis. Cancer Med 2023; 12:16793-16804. [PMID: 37403746 PMCID: PMC10501238 DOI: 10.1002/cam4.6301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Eribulin is currently recommended for the treatment of patients with metastatic breast cancer (MBC) pre-treated with taxanes and anthracyclines. The aim of the present study was to evaluate the effectiveness and safety of eribulin and its impact on health-related quality of life in heavily pre-treated patients with MBC. METHODS Data from MBC patients who had received eribulin-based therapy at Beijing Cancer Hospital between January 2020 and July 2022 were analyzed retrospectively. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), adverse effects (AEs) and health-related quality of life (HRQoL) were assessed. RESULTS Data from 118 patients who had received eribulin to treat MBC were included. Median PFS was 4.2 months and median OS had not been reached. The ORR was 13.6% (16/118) and DCR was 75.4% (89/118). The median PFS in patients who received eribulin in second-line (26/118), third-line (29/118), or fourth-line or later (63/118) was 4.5, 4.2, and 3.9 months, respectively. The median OS in patients who received eribulin in third- or later line (n = 92) was 14.1 months. Patients who received eribulin combination therapy had a significantly longer median PFS compared with those who received eribulin monotherapy (4.5 vs. 3.4 months, p = 0.007) and there was a trend towards a longer median OS (not reached vs. 12.1 months). The most common grade 3-4 adverse events were neutropenia (22.9%), leukocytopenia (13.6%) and asthenia/fatigue (8.5%), without significant differences in safety between eribulin monotherapy and combination therapy. Quality of life was similar in patients who received eribulin monotherapy and combination therapy, except for cognitive function and nausea and vomiting symptoms, which were better with combination therapy. CONCLUSIONS The present study suggests that eribulin-based therapy is an effective treatment option and well tolerated for heavily pre-treated patients with MBC. Eribulin combination therapy might improve PFS and HRQoL compared with eribulin monotherapy.
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Affiliation(s)
- Xinyu Gui
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Breast Oncology, Peking University Cancer Hospital & InstituteBeijing, China 100142China
| | - Xu Liang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Breast Oncology, Peking University Cancer Hospital & InstituteBeijing, China 100142China
| | - Huiping Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Breast Oncology, Peking University Cancer Hospital & InstituteBeijing, China 100142China
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Díaz-Acedo R, Artacho Criado S, Jiménez Galán R, Gutiérrez Pizarraya A, Galván Banqueri M, Rodríguez-de-la-Borbolla-Artacho M, Marcos Rodríguez JA, Márquez Saavedra E. Effectiveness and safety of eribulin for human epidermal growth factor receptor 2 negative metastatic breast cancer in a real-world population. J Oncol Pharm Pract 2021; 28:1573-1582. [PMID: 34558360 DOI: 10.1177/10781552211038241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Eribulin's clinical benefit remains unclear; so, studies analyzing its effectiveness in routine clinical practice are interesting. PATIENTS AND METHODS This is a multicenter, retrospective study including patients with human epidermal growth factor receptor-2-negative metastatic breast cancer which assesses effectiveness and safety of eribulin. RESULTS A total of 140 women were included, with a median age of 57 years. The median overall survival and progression-free survival were 8.8 (95% confidence interval: 6.1-11.4) and 2.8 months (95% confidence interval: 2.5-3.1), respectively. For patients with hormonal receptor expression, a significantly longer progression-free survival was observed: 3.4 (95%confidence interval: 2.3-4.5) versus triple negative: 2.0 (95%confidence interval: 1.7-2.3) months, p = 0.003. Also, those who had received capecitabine prior to eribulin had a higher median overall survival than those who had not received it (9.5 months, 95% confidence interval: 6.6-12.5 vs. 4.8 months, 95% confidence interval: 3.4-6.2; p = 0.001). When only triple-negative patients were included, median overall survival was 6.5 (95% confidence interval: 0.1-16.2) for those who had received previous capecitabine versus 4.3 (95% confidence interval: 2.8-5.8) months for patients who had not received it; p =0.006. The safety profile of eribulin was adequate. CONCLUSION Effectiveness of eribulin in a real-life human epidermal growth factor receptor-2--negative population is lower than that observed in clinical trials. Its benefit seems to be higher in patients with hormonal receptor expression and patients who had received capecitabine prior to eribulin. The safety profile of eribulin is adequate.
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Fabi A, Terrenato I, Vidiri A, Villani V, Tanzilli A, Airoldi M, Pedani F, Magri V, Palleschi M, Donadio M, Catania G, Nisticò C, Carapella C, Rudà R, Pace A, Maschio M, Telera S, Cognetti F. Eribulin in brain metastases of breast cancer: outcomes of the EBRAIM prospective observational trial. Future Oncol 2021; 17:3445-3456. [PMID: 34044585 DOI: 10.2217/fon-2021-0300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Eribulin shows some activity in controlling brain metastasis in breast cancer. Methods: This observational, multicenter study evaluated brain disease control rates, survival and safety in patients with brain metastatic breast cancer treated with eribulin in clinical practice. Results: A total of 34 patients were enrolled (mean age 49 years, 91% with visceral metastases) and 29 were evaluable for brain disease. Fourteen achieved disease control and showed a longer time without progression: 10 months (95% CI: 2.3-17.7) versus 4 months (95% CI: 3.3-4.7) in the control group (p = 0.029). Patients with clinical benefits at 6 months had longer survival. Leukopenia and neutropenia were the most frequent grade 3-4 toxicities. Conclusion: Eribulin confirms its effectiveness in patients with brain metastatic breast cancer. Further studies on larger cohorts are needed to confirm the results.
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Affiliation(s)
- Alessandra Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy.,Phase I Clinical Studies & Precision Medicine, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Irene Terrenato
- Clinical Trial Center - Biostatistics & Bioinformatics, IRCCS Regina Elena National Cancer Institute, 53 - 00144, Rome, Italy
| | - Antonello Vidiri
- Radiology & Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Veronica Villani
- Neuroncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Antonio Tanzilli
- Neuroncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Mario Airoldi
- Medical Oncology, Health & Science City, Corso Bramante 88, 10126, Turin, Italy
| | - Fulvia Pedani
- Medical Oncology, Health & Science City, Corso Bramante 88, 10126, Turin, Italy
| | - Valentina Magri
- Medical Oncology, La Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Michela Palleschi
- Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, 47014, Italy
| | - Michela Donadio
- Medical Oncology, Breast Unit, Health & Science City, Corso Bramante 88, 10126,Turin, Italy
| | - Giovanni Catania
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Cecilia Nisticò
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Carmine Carapella
- Neurosurgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health & Science, Corso Bramante 88, 10126, Turin, Italy
| | - Andrea Pace
- Neuroncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Marta Maschio
- Neuroncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Stefano Telera
- Neurosurgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
| | - Francesco Cognetti
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 - 00144, Rome, Italy
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Aogi K, Watanabe K, Kitada M, Sangai T, Ohtani S, Aruga T, Kawagichi H, Fujisawa T, Maeda S, Morimoto T, Sato N, Takao S, Morita S, Masuda N, Toi M, Ohno S. Clinical usefulness of eribulin as first- or second-line chemotherapy for recurrent HER2-negative breast cancer: a randomized phase II study (JBCRG-19). Int J Clin Oncol 2021; 26:1229-1236. [PMID: 33891194 PMCID: PMC8213561 DOI: 10.1007/s10147-021-01920-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/03/2021] [Indexed: 11/24/2022]
Abstract
Background Anthracycline (A) or taxane T-based regimens are the standard early-line chemotherapy for metastatic breast cancer (BC). A previous study has shown a survival benefit of eribulin in heavily pretreated advanced/recurrent BC patients. The present study aimed to compare the benefit of eribulin with treatment of physician’s choice (TPC) as first- or second-line chemotherapy for recurrent HER2-negative BC.
Methods Patients with recurrent HER2-negative BC previously receiving anthracycline and taxane AT-based chemotherapy in the adjuvant or first-line setting were eligible for this open-label, randomized, parallel-group study. Patients were randomized 1:1 by the minimization method to receive either eribulin (1.4 mg/m2 on day one and eight of each 21-day cycle) or TPC (paclitaxel, docetaxel, nab-paclitaxel or vinorelbine) until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Secondary endpoints included time to treatment failure (TTF), overall response rate (ORR), duration of response, and safety (UMIN000009886). Results Between May 2013 and January 2017, 58 patients were randomized, 57 of whom (26 eribulin and 31 TPC) were analyzed for efficacy. The median PFS was 6.6 months with eribulin versus 4.2 months with TPC (hazard ratio: 0.72 [95% confidence interval (CI), 0.40–1.30], p = 0.276). Median TTF was 6.0 months with eribulin versus 3.6 months with TPC (hazard ratio: 0.66 [95% CI, 0.39–1.14], p = 0.136). Other endpoints were also similar between groups. The most common grade ≥ 3 adverse event was neutropenia (22.2% with eribulin versus 16.1% with TPC). Conclusions Eribulin seemed to improve PFS or TTF compared with TPC without statistical significance. Further validation studies are needed.
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Kou 160, Minamiumemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Masahiro Kitada
- Breast Disease Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Takashi Sangai
- Department of Breast Thyroid Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hidetoshi Kawagichi
- Department of Breast Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomomi Fujisawa
- Department of Breast Oncology, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Shigeto Maeda
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Takashi Morimoto
- Department of Breast Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Shintaro Takao
- Department of Breast Surgery, Hyogo Cancer Center Hospital, Kobe, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Mavratzas A, Marmé F. Treatment of Luminal Metastatic Breast Cancer beyond CDK4/6 Inhibition: Is There a Standard of Care in Clinical Practice? Breast Care (Basel) 2021; 16:115-128. [PMID: 34012366 PMCID: PMC8114049 DOI: 10.1159/000514561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND CDK4/6 inhibitors have become the standard for first-line treatment of metastatic luminal breast cancer based on consistent data from several phase 3 trials demonstrating clinically meaningful improvement of progression-free as well as overall survival. In addition, they are about to become a part of adjuvant treatment for patients with high-risk luminal disease based on positive results from the first randomized phase 3 trial on abemaciclib. Nevertheless, the majority of patients with advanced or metastatic luminal breast cancer and prospectively a relevant proportion of patients treated in the adjuvant setting will eventually develop resistance to this endocrine based combination within 12-36 months, depending on the line of treatment. CONCLUSION Potential subsequent therapies include PI3K inhibitors, mTOR inhibitors, endocrine monotherapy, PARP inhibitors, and chemotherapy. However, these therapies have mainly been developed in the pre-CDK4/6 inhibitor era and little is known about potential cross-resistance. The concept of continuing CDK4/6 inhibition beyond progression is supported by some preclinical data, but to date there is very limited clinical evidence to support this strategy. Therefore, treatment of metastatic luminal breast cancer after progression on CDK4/6 inhibitors remains a challenge. KEY MESSAGES Here we review current evidence from pro- and retrospective studies and give an outlook on future developments with respect to novel therapeutic agents, including oral SERD and AKT inhibitors, which have the potential to change the therapeutic landscape in the future. Furthermore, clinical treatment algorithms and current research will also be discussed.
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Affiliation(s)
- Athanasios Mavratzas
- Section of Conservative Gynecologic Oncology, Experimental and Translational Gynecologic Oncology, Medical Faculty Mannheim, Heidelberg University, Department of Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Germany
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