1
|
Rhanine Y, Bonnefoi H, Goncalves A, Debled M, Le Moulec S, Bonichon N, Macgrogan G, Arnedos M, Dubroca-Dehez B, Grellety T. Efficacy of antiandrogens in androgen receptor-positive triple-negative metastatic breast cancer: Real-life data. Breast 2024; 73:103667. [PMID: 38160476 PMCID: PMC10792951 DOI: 10.1016/j.breast.2023.103667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Antiandrogens (AA) have been tested in clinical trials in androgen receptor (AR) + triple-negative breast cancer (TNBC). We aim to assess the clinical benefit rate (CBR) of AA in real life. The primary end-point was CBR at 6 months. Twenty-four patients were assessable and received: abiraterone acetate (62 %), enzalutamide (8 %) and bicalutamide (30 %). CBR at 6 months was 29 % (7/24) with 2 CR, 3 PR and 2 SD. Four patients had a clinical benefit >12 months. Real-life efficacy of AA use in metastatic AR + TNBC are in line with data from published trials.
Collapse
Affiliation(s)
- Yasmine Rhanine
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | - Hervé Bonnefoi
- Medical Oncology Department, Institut Bergonié and Université de Bordeaux, UFR Sciences Médicales, Bordeaux, France
| | - Anthony Goncalves
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Marc Debled
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | | | | | - Monica Arnedos
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - Thomas Grellety
- Medical Oncology Department, Centre Hospitalier de la Côte Basque, Bayonne, France.
| |
Collapse
|
2
|
Krajnak S, Decker T, Schollenberger L, Rosé C, Ruckes C, Fehm T, Thomssen C, Harbeck N, Schmidt M. Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2- breast cancer resistant to endocrine therapy: VinoMetro-AGO-B-046. J Cancer Res Clin Oncol 2021; 147:3391-3400. [PMID: 33743073 PMCID: PMC8484172 DOI: 10.1007/s00432-021-03599-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
Purpose Metronomic chemotherapy (MCT) is an increasingly used treatment option in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (MBC) after failure of endocrine-based therapies. Methods VinoMetro was a multicentre, open-label, single-arm, phase II study of metronomic oral vinorelbine (VRL; 30 mg/day) as a first-line chemotherapy (CT) in patients with HR+/HER2− MBC after endocrine failure. The primary endpoint was the clinical benefit rate (CBR) at 24 weeks. Results Between January 2017 and April 2019, nine patients were enrolled. The CBR was 22.2% (90% confidence interval [CI] 4.1–55.0), p = 0.211. The median progression-free survival (PFS) was 12.0 weeks (95% CI 11.3–12.7). Grade 3–4 adverse events (AEs) occurred in 22.2% of patients. One patient died of febrile neutropenia. Conclusion VinoMetro (AGO-B-046) was closed early after nine patients and occurrence of one grade 5 toxicity in agreement with the lead institutional review board (IRB). Metronomic dosing of oral VRL in HR+/HER2− MBC as first-line CT after failure of endocrine therapies showed only limited benefit in this population. Trial registration number and date of registration ClinicalTrials.gov Identifier: NCT03007992; December 15, 2016.
Collapse
Affiliation(s)
- Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre, Mainz, Germany
| | - Thomas Decker
- Haematology and Oncology Outpatient Clinic, Ravensburg, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Mainz, Germany
| | | | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Mainz, Germany
| | - Tanja Fehm
- Department of Gynaecology and Obstetrics, University Medical Centre, Düsseldorf, Germany
| | - Christoph Thomssen
- Department of Gynaecology, University Medical Centre, Halle (Saale), Germany
| | - Nadia Harbeck
- Breast Centre, Department of Gynaecology and Obstetrics and CCC Munich LMU, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre, Mainz, Germany.
| |
Collapse
|
3
|
KovaČ A, Matos E, Kuhar CG, Čakš M, Ovčariček T, Mencinger M, Humar M, Borštnar S. Efficacy and safety of selective cyclin-dependent kinases 4/6 inhibitors in hormone-receptor-positive, HER2-negative advanced breast cancer - results from a real-world setting. Cancer Treat Res Commun 2020; 25:100201. [PMID: 32979704 DOI: 10.1016/j.ctarc.2020.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Selective cyclin-dependent kinases 4/6 inhibitors (CDKi) have become the standard of care in patients with hormone receptor (HR)-positive, HER2-negative advanced breast cancer (ABC). We performed retrospective analysis in patients treated with CDKi in the first year of their routine clinical use in Slovenia. METHODS The primary goals were time-to-treatment failure (TTF) and overall survival (OS), analysed via Kaplan-Meier method, the secondary goals were clinical benefit rate (CBR) and safety. RESULTS Overall, 218 patients' data were evaluated. The median age was 61.8 years (30.6-84.6). The median number of previous ET lines for ABC was 2 (range 0-5). At the time of inclusion, 128 patients (58.7%) had visceral metastases, 45 patients (20.6%) had bone-only disease. At the median follow-up of 15.2 months, disease progressed in 74 patients and 60 patients died. The median TTF was 8.3 months for the whole group, 19.3, 10.3 and 5.5 months for patients treated in the first-, second- and further lines of systemic therapy, respectively. The median OS from the start of CDKi treatment was not reached in any of the groups. CBR was 59.6% for the whole group, 42.7% for further lines of therapy. The most common grade 3/4 adverse event was neutropaenia in 108 patients (49.5%), followed by an increase of hepatic aminotransferases in 13 patients (6.0%). CONCLUSIONS Even in the diverse real-world population treatment with CDKi in combination with ET showed clinical benefit, most prominently in the first- and second lines of systemic therapy.
Collapse
Affiliation(s)
- Anja KovaČ
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; Izola General Hospital, Polje 40, 6310 Izola, Slovenia.
| | - Erika Matos
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | | | - Marina Čakš
- University Clinical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Tanja Ovčariček
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Marina Mencinger
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Mojca Humar
- General Hospital "dr. Franc Derganc" Nova Gorica, Ulica padlih borcev 13A, 5290 Šempeter pri Gorici, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia.
| |
Collapse
|
4
|
Hirbe AC, Eulo V, Moon CI, Luo J, Myles S, Seetharam M, Toeniskoetter J, Kershner T, Haarberg S, Agulnik M, Monga V, Milhem M, Parkes A, Robinson S, Okuno S, Attia S, Van Tine BA. A phase II study of pazopanib as front-line therapy in patients with non-resectable or metastatic soft-tissue sarcomas who are not candidates for chemotherapy. Eur J Cancer 2020; 137:1-9. [PMID: 32712457 DOI: 10.1016/j.ejca.2020.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cytotoxic chemotherapy remains the standard of care first-line treatment for advanced and metastatic soft-tissue sarcomas (STSs). Certain patients may not be chemotherapy candidates based upon age or co-morbidities, leaving limited treatment options. Pazopanib is a multi-targeted tyrosine kinase inhibitor that is FDA-approved for metastatic STS after the first line. We proposed a phase II study evaluating pazopanib as a first-line agent in patients with advanced disease who are deemed not to be candidates for chemotherapy. METHODS Eligible patients were at least 18 years old, not candidates for chemotherapyand were treatment naive. Pazopanib was titrated from 200 mg twice daily to a goal of 800 mg daily. The primary end point was the clinical benefit rate (CBR) (CBR = completed response + partial response + stable disease per Response Evaluation Criteria in Solid Tumours [RECIST 1.1]) at 16 weeks. The sample size of 56 evaluable patients was calculated to provide 80% power to test a hypothesised CBR of ≥35% against an unfavourable CBR of ≤20%. If ≥ 17 patients achieved benefit, the null CBR of 20% would be rejected at a nominal 5% alpha level. Secondary end points included progression-free survival (PFS), overall survival (OS), quality of life and serum biomarkers. FINDINGS Fifty-six patients were enrolled from May 2015 to February 2019 and are included in the intention-to-treat analysis. Median PFS was 3.67 (2.62-7.25) months. Median OS was 14.16 (95% confidence interval [CI]: 8.4-NR) months, CBR = 39.29% (22/56) (CI = 0.265-0.533, p = 0.0007). No new or unexpected adverse events were seen. The most common grade I-II events were diarrhoea, nausea and fatigue. The most common grade III-IV events were hypertension and liver function test abnormalities. INTERPRETATION These data suggest that there is a benefit to front-line pazopanib in patients with STS who are not candidates for cytotoxic chemotherapy.
Collapse
|
5
|
Robertson JFR, Jiang Z, Di Leo A, Ohno S, Pritchard KI, Ellis M, Bradbury I, Campbell C. A meta-analysis of clinical benefit rates for fulvestrant 500 mg vs. alternative endocrine therapies for hormone receptor-positive advanced breast cancer. Breast Cancer 2019; 26:703-711. [PMID: 31079343 PMCID: PMC6821663 DOI: 10.1007/s12282-019-00973-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fulvestrant, a selective estrogen receptor degrader, is approved for first- and second-line treatment of postmenopausal women with hormone receptor-positive advanced breast cancer (ABC). METHODS Meta-analysis of randomized controlled trials (RCTs) evaluating fulvestrant 500 mg in postmenopausal hormone receptor-positive ABC, to evaluate differences in clinical benefit rate (CBR; proportion of patients experiencing best overall response of complete response, partial response, or stable disease for ≥ 24 weeks) between fulvestrant 500 mg and comparator endocrine therapies. Odds ratios (OR) and 95% confidence intervals (CI) for CBR were calculated; fixed effects (FE) models were constructed (first- and second-line data, alone and combined). RESULTS Six RCTs were included. Four studies evaluated fulvestrant 500 mg vs. fulvestrant 250 mg; two evaluated fulvestrant 500 mg vs. anastrozole 1 mg. In total, 1054 and 534 patients were included (first- and second-line treatment, respectively). Analysis of OR and 95% CI of CBR by therapy line favored fulvestrant 500 mg vs. comparator therapy. Assessing all results combined in the FE model indicated significant improvement in CBR with fulvestrant 500 mg vs. comparator treatments (OR 1.33; 95% CI 1.13-1.57; p = 0.001). Restricting the FE model to therapy line demonstrated significant improvement in CBR vs. comparator treatments (OR 1.33; 95% CI 1.02-1.73; p = 0.035) for first-line, and a trend to improvement vs. comparator treatments (OR 1.27; 95% CI 0.90-1.79; p = 0.174) for second-line. CONCLUSIONS In postmenopausal patients with hormone receptor-positive ABC, fulvestrant 500 mg first-line was associated with significantly greater CBR (more patients benefiting from treatment) vs. comparator endocrine therapy.
Collapse
Affiliation(s)
- John F R Robertson
- Division of Breast Surgery, The University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Zefei Jiang
- Department of Breast Cancer, Affiliated Hospital of Academy of Military Medical Sciences, No. 8 Dongda Street, Fengtai District, Beijing, 100071, China
| | - Angelo Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Piazza Dell'ospedale 2, 59100, Prato, Italy
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kathleen I Pritchard
- Sunnybrook Odette Cancer Centre and the University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Matthew Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, 6620 S Main St #1350, Houston, TX, 77030, USA
| | - Ian Bradbury
- Frontier Science, Grampian View, Kincraig, Kingussie, PH21 1NA, UK
| | | |
Collapse
|