Metastatic Breast Cancer: What is the real benefit of chemotherapy in clinical practice?
Bakker, J.L., Wever, K., Waesberghe, J.H. van, Beeker, A., Meijers, H., Konings, I.R., Verheul, H.M.W.
Voorzitter(s): prof.dr. R.P. Koopmans, Maastricht & dr. F.L.G. Erdkamp, Geleen
Locatie(s): Zaal 2.7/2.8
Categorie(ën):
Background: Efficacy of chemotherapeutic treatment in patients with metastatic breast cancer (MBC) is frequently determined in clinical trials. Inclusion criteria are stringent and these data do not reflect clinical practice
Objective: The purpose of this study is to describe chemotherapeutic treatment and determine benefit of it in an unselected cohort of patients with MBC.
Methods: In this retrospective analysis, the chemotherapeutic treatment of 91 patients diagnosed with MBC between January 2005 and January 2009 in two hospitals in the Netherlands was studied until their death.
Results: The median overall survival of patients with MBC after start of chemotherapy was 24 months (95% CI 20.3-27.7). Analysis showed that patients received a multitude of therapy lines; 30% of patients received five lines or more. First line chemotherapy was mostly anthracycline-based, followed by taxanes, capecitabine and vinorelbine. The objective response rates (ORR) decreased from 20% in the first line to 0% upon the fourth line. The clinical benefit rate (CBR; at least stable disease at first evaluation) was 85% in the first line and decreased to 54% upon the fourth line. Progression at first evaluation of a chemotherapeutic line affected the choice of treatment afterwards. Sixty-two percent of patients with progressive disease at first evaluation in previous line, compared to 23% in the group of patients without progression at first evaluation in previous line, did not receive a subsequent new chemotherapeutic agent and finally deceased. If the clinician did continue with a subsequent line of chemotherapy, the outcome was not significantly worse between these two groups of patients. This suggests that the clinicians were able to select those patients with a favourable clinical outcome for continuation of chemotherapeutic treatment.
Conclusion: This retrospective study describes the use of chemotherapy in MBC in clinical practice in the Netherlands. In contrast to phase III studies, the data give a complete insight in the chemotherapeutic treatment of an unselected heterogeneous group of MBC patients.
- Over Bakker, J.L.
- Over Wever, K.
- Over Waesberghe, J.H. van
- Over Beeker, A.
- Over Meijers, H.
- Over Konings, I.R.
- Over Verheul, H.M.W.