Factors affecting progression-free survival in hormone-dependent metastatic breast cancer patients receiving high-dose chemotherapy and hematopoietic progenitor cell transplantation: role of maintenance endocrine therapy

on behalf of Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule staminali emopoietiche e terapia cellulare (GITMO) -Sezione Tumori SolidiThe median survival of women with metastatic breast cancer (MBC) is 18-24 months, and fewer than 5% are alive and disease free at 5 years. We report toxicity and survival in a cohort of MBC patients receiving high-dose chemotherapy (HDC) with autologous hematopoietic SCT (AHSCT) in Italy between 1990 and 2005. Data set for survival analysis has been obtained for 415 patients. Clinical parameters including probability of transplant-related mortality (TRM), PFS and OS. With a median follow-up of 27 months (range 0-172), OS and PFS at 5 and 10 years in the whole population were 47/23 and 32/14%, respectively. A total 239 patients are alive with a median follow-up of 33 months (range 2-174). Survival was significantly more pronounced in patients harboring hormone receptor positive tumors (P ¼ 0.028), without visceral metastases (P ¼ 0.009) and in women with chemosensitive disease (Po0.0001). Sixty eight patients (20.4%) who received HDC in partial response, stable or progressive disease underwent conversion to CR. TRM was 2.5% overall and 1.3% since 2000. Our findings suggest that could be a role for HDC and AHSCT in delaying disease progression and possibly cure a subset of MBC patient harboring chemosensitive tumors.

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“…35 Unfortunately, in our series, no sufficient data on HER-2 expression were available for a subset analysis.…”

Section: Hdc For Metastatic Breast Cancer In Italy M Martino Et Almentioning

confidence: 99%

Long-term survival in patients with metastatic breast cancer receiving intensified chemotherapy and stem cell rescue: data from the Italian registry

Martino¹,

Ballestrero

Zambelli

et al. 2012

Bone Marrow Transplant

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“…However, without a quantification of these effects, this clinical practice is hardly defensible as evidence based. The only prospective study available so far was conducted with medroxyprogesterone acetate in a mixed population of ER-positive and ER-negative patients [5]; two other studies have suggested benefit from maintenance hormone therapy after conventional [11] and high-dose chemotherapy [12], respectively, but their retrospective nature does not allow firm conclusions.…”

Section: Discussionmentioning

confidence: 99%

Maintenance Hormone Therapy with Letrozole after First-Line Chemotherapy for Advanced Breast Cancer

Bertelli

Garrone²,

Bertolotti³

et al. 2005

Oncology

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Objectives: Maintenance hormone therapy after first-line chemotherapy is routinely used by many clinicians in advanced breast cancer patients with potentially hormone-sensitive tumors, although there are insufficient evidences in the literature to support this practice. We investigated the effects of the third-generation aromatase inhibitor letrozole as a maintenance therapy in postmenopausal patients who had responded or had stable disease with first-line chemotherapy. Methods: Fifty-eight patients (median age 62 years, range 31–80) were recruited and received letrozole, 2.5 mg/day starting within 8 weeks since the last cycle of chemotherapy. Estrogen and/or progesterone receptor status was positive in 81% of the patients, unknown in 19%; 57% of the patients had visceral disease. First-line chemotherapy included anthracyclines and/or taxanes in 74% of cases. Results: The median time to progression (TTP) from starting letrozole was 18.5 months. A shorter TTP was found in patients with abnormal CA 15-3 levels at the start of maintenance letrozole (median TTP, 9.9 months: p = 0.01), or with levels increasing >25% from baseline during the first 6 months of letrozole therapy (median TTP, 8.2 months: p < 0.0001). Response status improved during letrozole in 15.5% of patients who had obtained less than a complete response to chemotherapy. Maintenance treatment was well tolerated and had no significant impact on quality of life scores. Conclusions: This study provides evidence in support of the common clinical practice of maintenance hormone therapy after chemotherapy in suitably selected patients with advanced breast cancer.

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“…The results seen in the patients in this study are very similar to those seen in patients who underwent autologous transplantation for metastatic breast cancer. 10,11 However, given their high rate of relapse, this patient population can be a testing ground for novel therapy.…”

Section: Discussionmentioning

confidence: 99%

High-dose chemotherapy and autologous peripheral blood stem cell transplantation for primary breast cancer refractory to neoadjuvant chemotherapy

Ueno

Konoplev

Buchholz

et al. 2006

Bone Marrow Transplant

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Factors affecting progression-free survival in hormone-dependent metastatic breast cancer patients receiving high-dose chemotherapy and hematopoietic progenitor cell transplantation: role of maintenance endocrine therapy

Cited by 20 publications

References 20 publications

Long-term survival in patients with metastatic breast cancer receiving intensified chemotherapy and stem cell rescue: data from the Italian registry

Long-term survival in patients with metastatic breast cancer receiving intensified chemotherapy and stem cell rescue: data from the Italian registry

Maintenance Hormone Therapy with Letrozole after First-Line Chemotherapy for Advanced Breast Cancer

High-dose chemotherapy and autologous peripheral blood stem cell transplantation for primary breast cancer refractory to neoadjuvant chemotherapy

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