Skip to main content
Top
Published in: Breast Cancer Research and Treatment 2/2008

01-01-2008 | Clinical Trial

Impact of chemotherapy beyond the first line in patients with metastatic breast cancer

Authors: Armelle Dufresne, Xavier Pivot, Christophe Tournigand, Thomas Facchini, Thierry Altweegg, Loic Chaigneau, Aimery De Gramont

Published in: Breast Cancer Research and Treatment | Issue 2/2008

Login to get access

Abstract

Purpose

The goal of this study was to determine which benefit could be brought by the succession of chemotherapy lines in patients treated for metastatic breast cancer and to identify patients who benefit from these treatments.

Patients and methods

Nine hundred and thirty four patients with metastatic breast cancer diagnosed between 1992 and 2002 were studied. A total of 772, 505, 283, 127 and 55 patients received a first, second, third, fourth and fifth line of chemotherapy, respectively. The evaluation of benefit in each chemotherapy lines was based on time of disease control (TDC). TDC is defined as time between the date of the beginning of treatment and the date of progression of disease or death. In case of early progressive disease or progression diagnosed at the first evaluation, TDC value is zero. Cox proportional hazards model was used to identify factors that could influence the TDC in each line of chemotherapy.

Results

Medians duration of TDC are 9.3 [0–120], 5.9 [0–83.6], 4.63 [0–37.2], 4.1 [0–36.7] and 0.23 months [0–15] in first, second, third, fourth and fifth lines, respectively. More interestingly, TDC was longer than 6 months in 50.5% of patients treated with second line, 40% with third line, 35% with fourth line and 23.5% with fifth line. These results justify the therapeutic succession of chemotherapy lines in metastatic breast cancer. Only one factor influences the duration of TDC for each line of treatment: duration of TDC observed in the previous line.
Literature
1.
go back to reference Parkin DM, Bray F, Ferlay J et al (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94(2):153–156PubMedCrossRef Parkin DM, Bray F, Ferlay J et al (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94(2):153–156PubMedCrossRef
2.
go back to reference Dickson R, Pestell R, Lippman M (2005) Metastatic breast cancer. In: DeVita T, Hellman S, Rosenberg S (eds) Cancer principles and practice of oncology, 7 edn. Lippincot company, Philadelphia, pp 1453–1462 Dickson R, Pestell R, Lippman M (2005) Metastatic breast cancer. In: DeVita T, Hellman S, Rosenberg S (eds) Cancer principles and practice of oncology, 7 edn. Lippincot company, Philadelphia, pp 1453–1462
3.
go back to reference Ellis M, Hayes D, Lippman M (2000) Treatment of metastatic breast cancer. In: Harris J, Lippman M, Morrow M, Osborne C (eds) Diseases of the breast, 2 edn. Lippincot company, Philadelphia, pp 749–797 Ellis M, Hayes D, Lippman M (2000) Treatment of metastatic breast cancer. In: Harris J, Lippman M, Morrow M, Osborne C (eds) Diseases of the breast, 2 edn. Lippincot company, Philadelphia, pp 749–797
4.
go back to reference Giordano SH, Buzdar AU, Smith TL et al (2004) Is breast cancer survival improving? Cancer 100(1):44–52PubMedCrossRef Giordano SH, Buzdar AU, Smith TL et al (2004) Is breast cancer survival improving? Cancer 100(1):44–52PubMedCrossRef
5.
go back to reference Fossati R, Confalonieri C, Torri V et al (1998) Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women. J Clin Oncol 16(10):3439–3460PubMed Fossati R, Confalonieri C, Torri V et al (1998) Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women. J Clin Oncol 16(10):3439–3460PubMed
6.
go back to reference A’Hern RP, Smith IE, Ebbs SR (1993) Chemotherapy and survival in advanced breast cancer: the inclusion of doxorubicin in Cooper type regimens. Br J Cancer 67(4):801–805PubMed A’Hern RP, Smith IE, Ebbs SR (1993) Chemotherapy and survival in advanced breast cancer: the inclusion of doxorubicin in Cooper type regimens. Br J Cancer 67(4):801–805PubMed
7.
go back to reference Andre F, Slimane K, Bachelot T et al (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22(16):3302–3308PubMedCrossRef Andre F, Slimane K, Bachelot T et al (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22(16):3302–3308PubMedCrossRef
8.
go back to reference Jassem J, Pienkowski T, Pluzanska A et al (2001) Doxorubicin and paclitaxel versus fluorouracil, doxorubicin, and cyclophosphamide as first-line therapy for women with metastatic breast cancer: final results of a randomized phase III multicenter trial. J Clin Oncol 19(6):1707–1715PubMed Jassem J, Pienkowski T, Pluzanska A et al (2001) Doxorubicin and paclitaxel versus fluorouracil, doxorubicin, and cyclophosphamide as first-line therapy for women with metastatic breast cancer: final results of a randomized phase III multicenter trial. J Clin Oncol 19(6):1707–1715PubMed
9.
go back to reference Alba E, Martin M, Ramos M et al (2004) Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first-line treatment of metastatic breast cancer: a Spanish Breast Cancer Research Group (GEICAM-9903) phase III study. J Clin Oncol 22(13):2587–2593PubMedCrossRef Alba E, Martin M, Ramos M et al (2004) Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first-line treatment of metastatic breast cancer: a Spanish Breast Cancer Research Group (GEICAM-9903) phase III study. J Clin Oncol 22(13):2587–2593PubMedCrossRef
10.
go back to reference Biganzoli L, Cufer T, Bruning P et al (2002) Doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in metastatic breast cancer: The European Organization for Research and Treatment of Cancer 10961 Multicenter Phase III Trial. J Clin Oncol 20(14):3114–3121PubMedCrossRef Biganzoli L, Cufer T, Bruning P et al (2002) Doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in metastatic breast cancer: The European Organization for Research and Treatment of Cancer 10961 Multicenter Phase III Trial. J Clin Oncol 20(14):3114–3121PubMedCrossRef
11.
go back to reference Sledge GW, Neuberg D, Bernardo P et al (2003) Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J Clin Oncol 21(4):588–592PubMedCrossRef Sledge GW, Neuberg D, Bernardo P et al (2003) Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J Clin Oncol 21(4):588–592PubMedCrossRef
12.
go back to reference Nabholtz JM, Falkson C, Campos D et al (2003) Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol 21(6):968–975PubMedCrossRef Nabholtz JM, Falkson C, Campos D et al (2003) Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol 21(6):968–975PubMedCrossRef
13.
go back to reference Ejlertsen B, Mouridsen HT, Langkjer ST et al (2004) Phase III study of intravenous vinorelbine in combination with epirubicin versus epirubicin alone in patients with advanced breast cancer: a Scandinavian Breast Group Trial (SBG9403). J Clin Oncol 22(12):2313–2320PubMedCrossRef Ejlertsen B, Mouridsen HT, Langkjer ST et al (2004) Phase III study of intravenous vinorelbine in combination with epirubicin versus epirubicin alone in patients with advanced breast cancer: a Scandinavian Breast Group Trial (SBG9403). J Clin Oncol 22(12):2313–2320PubMedCrossRef
14.
go back to reference Nabholtz JM, Senn HJ, Bezwoda WR et al (1999) Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group. J Clin Oncol 17(5):1413–1424PubMed Nabholtz JM, Senn HJ, Bezwoda WR et al (1999) Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group. J Clin Oncol 17(5):1413–1424PubMed
15.
go back to reference Sjostrom J, Blomqvist C, Mouridsen H et al (1999) Docetaxel compared with sequential methotrexate and 5-fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomised phase III study with crossover on progression by the Scandinavian Breast Group. Eur J Cancer 35(8):1194–1201PubMedCrossRef Sjostrom J, Blomqvist C, Mouridsen H et al (1999) Docetaxel compared with sequential methotrexate and 5-fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomised phase III study with crossover on progression by the Scandinavian Breast Group. Eur J Cancer 35(8):1194–1201PubMedCrossRef
16.
go back to reference O’Shaughnessy J, Miles D, Vukelja S et al (2002) Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results. J Clin Oncol 20(12):2812–2823PubMedCrossRef O’Shaughnessy J, Miles D, Vukelja S et al (2002) Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results. J Clin Oncol 20(12):2812–2823PubMedCrossRef
17.
go back to reference Greenberg PA, Hortobagyi GN, Smith TL et al (1996) Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol 14(8):2197–2205PubMed Greenberg PA, Hortobagyi GN, Smith TL et al (1996) Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol 14(8):2197–2205PubMed
18.
go back to reference Pivot X, Asmar L, Buzdar AU et al (2000) A unified definition of clinical anthracycline resistance breast cancer. Br J Cancer 82(3):529–534PubMedCrossRef Pivot X, Asmar L, Buzdar AU et al (2000) A unified definition of clinical anthracycline resistance breast cancer. Br J Cancer 82(3):529–534PubMedCrossRef
19.
go back to reference Cardoso F, Di LA, Lohrisch C et al (2002) Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol 13(2):197–207PubMedCrossRef Cardoso F, Di LA, Lohrisch C et al (2002) Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol 13(2):197–207PubMedCrossRef
20.
go back to reference Ramirez AJ, Towlson KE, Leaning MS et al (1998) Do patients with advanced breast cancer benefit from chemotherapy? Br J Cancer 78(11):1488–1494PubMed Ramirez AJ, Towlson KE, Leaning MS et al (1998) Do patients with advanced breast cancer benefit from chemotherapy? Br J Cancer 78(11):1488–1494PubMed
21.
go back to reference Modi S, Panageas KS, Duck ET et al (2002) Prospective exploratory analysis of the association between tumor response, quality of life, and expenditures among patients receiving paclitaxel monotherapy for refractory metastatic breast cancer. J Clin Oncol 20(17):3665–3673PubMedCrossRef Modi S, Panageas KS, Duck ET et al (2002) Prospective exploratory analysis of the association between tumor response, quality of life, and expenditures among patients receiving paclitaxel monotherapy for refractory metastatic breast cancer. J Clin Oncol 20(17):3665–3673PubMedCrossRef
22.
go back to reference Geels P, Eisenhauer E, Bezjak A et al (2000) Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 18(12):2395–2405PubMed Geels P, Eisenhauer E, Bezjak A et al (2000) Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 18(12):2395–2405PubMed
23.
go back to reference Coates AS, Hurny C, Peterson HF et al (2000) Quality-of-life scores predict outcome in metastatic but not early breast cancer. International Breast Cancer Study Group. J Clin Oncol 18(22):3768–3774PubMed Coates AS, Hurny C, Peterson HF et al (2000) Quality-of-life scores predict outcome in metastatic but not early breast cancer. International Breast Cancer Study Group. J Clin Oncol 18(22):3768–3774PubMed
24.
go back to reference Efficace F, Biganzoli L, Piccart M et al (2004) Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. Eur J Cancer 40(7):1021–1030PubMedCrossRef Efficace F, Biganzoli L, Piccart M et al (2004) Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. Eur J Cancer 40(7):1021–1030PubMedCrossRef
25.
go back to reference Coates A, Gebski V, Bishop JF et al (1987) Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. N Engl J Med 317(24):1490–1495PubMedCrossRef Coates A, Gebski V, Bishop JF et al (1987) Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. N Engl J Med 317(24):1490–1495PubMedCrossRef
26.
go back to reference Rizzieri DA, Vredenburgh JJ, Jones R et al (1999) Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support. J Clin Oncol 17(10):3064–3074PubMed Rizzieri DA, Vredenburgh JJ, Jones R et al (1999) Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support. J Clin Oncol 17(10):3064–3074PubMed
27.
go back to reference Nisman B, Barak V, Hubert A et al (2003) Prognostic factors for survival in metastatic breast cancer during first-line paclitaxel chemotherapy. Anticancer Res 23(2C):1939–1942PubMed Nisman B, Barak V, Hubert A et al (2003) Prognostic factors for survival in metastatic breast cancer during first-line paclitaxel chemotherapy. Anticancer Res 23(2C):1939–1942PubMed
28.
go back to reference Nomura Y (1998) Different survival determinants of metastatic breast cancer patients treated with endocrine therapy or chemo-endocrine therapy. Int J Oncol 12(4):817–824PubMed Nomura Y (1998) Different survival determinants of metastatic breast cancer patients treated with endocrine therapy or chemo-endocrine therapy. Int J Oncol 12(4):817–824PubMed
29.
go back to reference Falkson G, Holcroft C, Gelman RS et al (1995) Ten-year follow-up study of premenopausal women with metastatic breast cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol 13(6):1453–1458PubMed Falkson G, Holcroft C, Gelman RS et al (1995) Ten-year follow-up study of premenopausal women with metastatic breast cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol 13(6):1453–1458PubMed
30.
go back to reference Yamamoto N, Watanabe T, Katsumata N et al (1998) Construction and validation of a practical prognostic index for patients with metastatic breast cancer. J Clin Oncol 16(7):2401–2408PubMed Yamamoto N, Watanabe T, Katsumata N et al (1998) Construction and validation of a practical prognostic index for patients with metastatic breast cancer. J Clin Oncol 16(7):2401–2408PubMed
31.
go back to reference Alexandre J, Bleuzen P, Bonneterre J et al (2000) Factors predicting for efficacy and safety of docetaxel in a compassionate-use cohort of 825 heavily pretreated advanced breast cancer patients. J Clin Oncol 18(3):562–573PubMed Alexandre J, Bleuzen P, Bonneterre J et al (2000) Factors predicting for efficacy and safety of docetaxel in a compassionate-use cohort of 825 heavily pretreated advanced breast cancer patients. J Clin Oncol 18(3):562–573PubMed
32.
go back to reference Hortobagyi GN, Smith TL, Legha SS et al (1983) Multivariate analysis of prognostic factors in metastatic breast cancer. J Clin Oncol 1(12):776–786PubMed Hortobagyi GN, Smith TL, Legha SS et al (1983) Multivariate analysis of prognostic factors in metastatic breast cancer. J Clin Oncol 1(12):776–786PubMed
33.
go back to reference McQuellon RP, Muss HB, Hoffman SL et al (1995) Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer. J Clin Oncol 13(4):858–868PubMed McQuellon RP, Muss HB, Hoffman SL et al (1995) Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer. J Clin Oncol 13(4):858–868PubMed
34.
go back to reference Bremnes RM, Andersen K, Wist EA (1995) Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. Eur J Cancer 31A(12):1955–1959PubMedCrossRef Bremnes RM, Andersen K, Wist EA (1995) Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. Eur J Cancer 31A(12):1955–1959PubMedCrossRef
Metadata
Title
Impact of chemotherapy beyond the first line in patients with metastatic breast cancer
Authors
Armelle Dufresne
Xavier Pivot
Christophe Tournigand
Thomas Facchini
Thierry Altweegg
Loic Chaigneau
Aimery De Gramont
Publication date
01-01-2008
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2008
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-007-9550-7

Other articles of this Issue 2/2008

Breast Cancer Research and Treatment 2/2008 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine