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Continuous chemotherapy confers survival, quality-of-life benefits in advanced breast cancer
Continuous chemotherapy appeared associated with superior OS and quality-of-life benefits compared with intermittent chemotherapy among patients with advanced breast cancer, according to results of two analyses scheduled for presentation at European Society for Medical Oncology Breast Cancer Congress.
“Based on our findings, you could hypothesize that the benefits of a continuous approach might be independent of the investigated treatment line and might apply to other lines of treatment as well,” Anouk Claessens, MD, PhD, medical oncologist at Zuyderland Medical Center in the Netherlands, said in a press release. “The challenge for clinical practice is to use agents that are well-tolerated and can be continued for a prolonged period without interruptions.”
The randomized, phase 3 Stop & Go trial investigated the safety and effectiveness of intermittent vs. continuous scheduling of chemotherapy in two treatment lines among patients with HER2-negative advanced breast cancer.
Researchers randomly assigned 420 patients to an intermittent schedule of two sets of four cycles of chemotherapy or a continuous schedule of eight consecutive cycles of the same chemotherapy. Regimens included first-line paclitaxel in combination with bevacizumab (Avastin, Genentech) and second-line capecitabine or nonpegylated liposomal doxorubicin.
In the first analysis, researchers evaluated PFS among 270 patients who continued to second-line intermittent (n = 131) or continuous (n= 139) therapy.
Results showed median PFS of 3.5 months for patients in the intermittent group and 5 months in the continuous group (HR = 1.04; 95% CI, 0.69-1.57). Median first- and second-line PFS combined for this cohort was 14.6 months with intermittent therapy vs. 16.6 months with continuous therapy (HR = 1.59; 95% CI, 1.04-2.45).
Median OS in the second line was 10.6 months for patients in the intermittent group and 12 months for patients in the continuous group (HR = 1.64; 95% CI, 1.08-2.48).
Patients in the intermittent arm also had shorter median OS from randomization vs. patients in the continuous arm (20.3 months vs. 23 months; HR = 1.93; 95% CI, 1.26-2.95).
The second analysis prospectively evaluated quality of life among 398 patients from the Stop & Go trial.
Researchers measured quality of life through questionnaires distributed every 12 weeks during the trial and follow-up period. They presented physical and mental scores as T-scores with a mean of 50, with higher numbers representing better quality of life.
Estimating differences in the course of these scores from baseline between the treatment groups served as the primary objective.
Median follow-up was 11.3 months (interquartile range, 5.6-22.2).
Results showed mean baseline scores of 37.9 for physical and 44.7 for mental in the intermittent group and 38.3 for physical and 42.5 for mental in the continuous group.
Physical quality of life declined in the intermittent group, resulting in a clinically meaningful difference of 5.68 points at 24 months (P < .001). Physical quality-of-life scores in the continuous group stabilized after a decline of ± 3.5 points.
Mental quality of life improved slightly in both groups at 12 months. Patients in the intermittent group reported an overall increase of 1.86 points (P = .012) whereas patients in the continuous group reported an increase of 2.53 points (P = .001).
Both groups favored continuous treatment when comparing both mental and physical quality-of-life changes from baseline through 30 months, with maximum differences of 3.11 points in physical and 3.32 points in mental quality of life.
“Both studies confirm the current national and international guidelines that chemotherapy, preferentially monotherapy — at least after the first line — should be given continuously as long as it is well-tolerated and effective,” Nadia Harbeck, MD, PhD, head of the breast center at University of Munich who was not involved with the study, said in a press release. “Until now, we’ve only had evidence from older studies, with regimens no longer used, indicating that continuous chemotherapy in metastatic disease is better than shorter. The new Stop & Go data confirm these older data also with more modern regimens.”– by John DeRosier
References:
Erdkamp FLG, et al. Abstract 158P_PR. Presented at: ESMO Breast Cancer Congress; May 2-4, 2019; Berlin.
Claessens AKM, et al. Abstract 159P_PR. Presented at: ESMO Breast Cancer Congress; May 2-4, 2019; Berlin.
Disclosures: Claessens and Harbeck report no relevant financial disclosures. Please see the abstracts for all other authors’ relevant financial disclosures.