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

Abstract

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.

Efficacy and Safety of Fulvestrant 500mg in Hormone-receptor Positive Human Epidermal Receptor 2 Negative Advanced Breast Cancer: A Real-world Study in China

“…This is a relatively new perspective because maintenance with endocrine therapy after chemotherapy is a considerable treatment pattern especially when the expected benefit of continuous chemotherapy is limited or the toxicity is unbearable. A small number of previous studies supported this treatment pattern, but none of them mainly used Fulvestrant as a maintenance drug [33] . A retrospective study investigating the efficacy of maintenance hormone therapy showed that median PFS of maintenance hormone therapy was 14.4 months (95% CI: 11.6-17.3 months), but 98.5% of the enrolled patients received AI or SERMs as maintenance therapy instead of Fulvestrant [34] .…”

Capecitabine maintenance therapy following docetaxel/capecitabine combination treatment in patients with metastatic breast cancer

“…For hormone receptor-positive patients, maintenance with endocrine therapy, such as tamoxifen, anastrazole, letrozole or exemestane, is preferred by a number of clinicians. Although available data is limited, a study by Bertelli et al (16), supports this approach. Letrozole provided a median TTP of 18.5 months in 58 postmenopausal patients who attained disease control with first-line chemotherapy.…”

First-line chemotherapy with docetaxel plus capecitabine followed by capecitabine or hormone maintenance therapy for the treatment of metastatic breast cancer patients

“…In addition to efficacy, the convenience and tolerability of the maintenance treatment must be considered; for example, intravenous chemotherapy requires frequent hospital visits for the patient, which are associated decreased quality of life for patients and increased healthcare worker costs. Therefore, the majority of patients prefer oral as opossed to intravenous chemotherapy ( 7 , 8 ), for example oral capecitabine.…”