Over the last 35 years, non-hormonal treatments have improved overall survival of patients with advanced breast cancer.
So say Greek researchers who conducted a review of 128 clinical trials that included more than 26,000 women with the disease.
The review showed that use of anthracycline regimens led to a 22 percent relative risk reduction in overall death, compared with older single-agent chemotherapy. Single drug taxane treatment led to a relative risk reduction of 33 percent, while a combination of a taxane with capecitabine or gemcitabine led to a 51 percent relative risk reduction over single-agent chemotherapy.
Most of the regimens appeared to be effective whether or not women had received a prior treatment.
"Our meta-analysis quantifies the progress achieved in the treatment of advanced breast cancer with nonhormonal systemic treatment in the last 35 years. Several regimens have shown effectiveness, and for some of them, the treatment effects are practically indistinguishable in magnitude," the review authors wrote. "Given that subsequent lines of treatment can confer similar relative benefits as the first-line setting, one can exploit the survival benefits conferred by several effective regimens used in sequential fashion."
The study was published Dec. 9 in the Journal of the National Cancer Institute.
This review is important because there has been no consensus regarding the best dosage, timing, sequence or combination of therapies for treatment of metastatic breast cancer, due to the fact that standard comparators haven't been available, Dr. Philippe Bedard and Dr. Martine Piccart-Gebhart, of the Jules Bordet Institute in Brussels, Belgium, wrote in an accompanying editorial.
The finding that many of the regimens have similar relative effectiveness in both untreated and previously treated patients means that other considerations, such as toxicity, will continue to help determine the choice of regimen for individual patients, the researchers said.
"Although this network meta-analysis is unlikely to alter routine clinical practice, it provides a solid evidence-based foundation to support the observation that the survival of women diagnosed with advanced breast cancer has improved because of more active systemic chemotherapy and targeted therapy," Bedard and Piccart-Gebhart wrote. "This should provide hope to patients, investigators, industrial sponsors, and regulatory agencies alike that well-designed clinical trials with novel systemic therapies can further alter the natural history of this devastating disease."
More information
Breastcancer.org has more about recurrent and metastatic breast cancer.
SOURCE: Journal of the National Cancer Institute, news release, Dec. 9, 2008
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