The efficacy and safety of paclitaxel plus bevacizumab therapy in breast cancer patients with visceral crisis

Funasaka, Chikako; Naito, Yoichi; Kusuhara, Shota; Nakao, Tomohiro; Fukasawa, Yoko; Mamishin, Kanako; Komuro, Ayumi; Okunaka, Mashiro; Kondoh, Chihiro; Harano, Kenichi; Kogawa, Takahiro; Matsubara, Nobuaki; Hosono, Ako; Kawasaki, Toshikatsu; Mukohara, Toru

doi:10.1016/j.breast.2021.04.001

Cited by 6 publications

(15 citation statements)

References 20 publications

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“…This is similar to our findings (49.5 years). We found that the majority (118 cases, 89.39%) of patients with VC were older than 60 years, invasive ductal carcinoma was the most common pathological type (123 cases, 93.18%), and HR+, Her-2− type was the most common molecular type (92cases, 69.18%), which was consistent with the reported literature ( 2 , 11 ).…”

Section: Discussionsupporting

confidence: 91%

“…We counted AEs occurring with different treatment regimens, and granulocytopenia was the most common in the chemotherapy group ( Table 3 ), which was similar to the findings of Chikako et al. ( 11 ). The proportion of AEs was less in the targeted therapy and ET groups than in the chemotherapy group.…”

Section: Discussionsupporting

confidence: 68%

“…It has been reported that the most benefit in survival time is presented by Chikako et al. who retrospectively analyzed 44 patients with VC receiving paclitaxel combined with bevacizumab chemotherapy, with an mPFS of about 4 months and an mOS of about 10 months ( 11 ). This is consistent with our VC patients ( Supplementary Table S5 ).…”

Section: Discussionmentioning

confidence: 99%

“…VC has a poor prognosis with an overall survival (OS) of only 3.7 months ( 2 ). About 70% of VC patients were hormone receptor (HR) positive ( 2 , 11 ). However, their OS was not significantly longer in patients receiving chemotherapy compared with palliative care.…”

Section: Introductionmentioning

confidence: 99%

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Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Yang

Lu²,

Lv³

et al. 2022

Front. Oncol.

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ObjectiveBreast cancer visceral crisis (VC) is caused by excessive tumor burden leading to severe organ dysfunction with poor prognosis. Traditional chemotherapy reduces the quality of life of patients without significantly improving survival. The aim of this study was to investigate the clinical characteristics of patients with VC and the prognosis by using different treatment options.MethodsAccording to the 5th European School of Oncology (ESO)–European Society for Medical Oncology (ESMO) international consensus guidelines for advanced breast cancer guidelines (ABC 5), patients who were treated in the First Hospital of Jilin University from 2018 to 2022 and diagnosed with breast cancer VC were retrospectively analyzed. The analysis focused on the characteristics of the patients, the treatment regimens, and prognosis.ResultsA total of 133 patients were included in this study. As for metastasis breast cancer subtype, 92 (69.18%) were hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER-2) negative, 20 (15.04%) had HER-2 overexpression, and 21 (15.78%) were triple negative. All patients had an mOS of 11.2 months (range, 1.1–107.8 months). In different types of VC, the median overall survival (mOS) of bone marrow metastasis (BMM) was 18.0 months (range, 2.0–107.8 months), that of diffuse liver metastasis (DLM) was 8.1 months (range, 1.3–30.2 months), and that of meningeal metastasis (MM) was 9.0 months (range, 1.2–53.8 months). In 92 HR+, Her-2− patients using different treatment regimens, mOS was 6.2 months (range, 1.2–29.8 months) in the chemotherapy group while it was 24.3 months (range, 3.1–107.8 months) in the endocrine therapy (ET) group. Multivariate Cox regression analysis suggested that Eastern Cooperative Oncology Group (ECOG) scores and type of VC were associated with survival.ConclusionPrognosis varied in different types of VC. Patients with BMM had the best prognosis, and DLM had the worst. As treatment options continue to progress, our retrospective study showed a significant prolongation of overall survival (OS) in patients with VC compared to previous studies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Yang

Lu²,

Lv³

et al. 2022

Front. Oncol.

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“…The proportion of patients still on treatment after 3 months was 68% and mOS was about 1 year (323 days). Weekly administration and paclitaxel dose adjustment resulted in a safety profile comparable to that previously reported with this combination; nonetheless, 30% of patients permanently discontinued treatment due to adverse events [ 17 ].…”

Section: The Clinical Management Of Visceral Crisismentioning

confidence: 55%

Clinical Review on the Management of Breast Cancer Visceral Crisis

et al. 2023

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Visceral crisis is a life-threatening clinical condition requiring urgent treatment and accounts for 10–15% of new advanced breast cancer diagnoses, mainly hormone receptor-positive/human epidermal growth factor 2 negative. As its clinical definition is an open topic with nebulous criteria and much room for subjective interpretation, it poses a challenge for daily clinical practice. International guidelines recommend combined chemotherapy as first-line treatment for patients with visceral crisis, but with modest results and a very poor prognosis. Visceral crisis has always been a common exclusion criterion in breast cancer trials, and the available evidence mainly comes from limited retrospective studies which are not sufficient to draw solid conclusions. The outstanding efficacy of innovative drugs, such as CDK4/6 inhibitors, questions the role of chemotherapy in this setting. In the lack of clinical reviews, we aim to critically discuss the management of visceral crisis, advocating future treatment perspectives for this challenging condition.

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CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2- advanced breast cancer with impending or established visceral crisis

Behrouzi

Armstrong

Howell

2023

Breast Cancer Res Treat

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Purpose ER+/HER2- advanced breast cancer (ABC) with visceral crisis (VC) or impending VC (IVC) is commonly treated with chemotherapy instead of CDK4/6 inhibitors (CDK4/6i). However, there is little evidence to confirm which treatment is superior. This study compared outcomes of patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i or weekly paclitaxel. Methods Patients with ER+/HER2- ABC receiving first line treatment at a large tertiary UK cancer centre from 1-Mar-2017 to 30-Jun-2021 were retrospectively identified. Hospital records were screened for IVC/VC affecting the liver, lungs/mediastinum, gastrointestinal tract and/or bone marrow. Baseline demographics, clinical data and survival outcomes were recorded up to 30-Jul-2022. Results 27/396 (6.8%) patients with ABC who received CDK4/6i and 32/86 (37.2%) who received paclitaxel had IVC/VC. Median time to treatment failure (TTF), progression-free survival (PFS) and overall survival (OS) were significantly longer in the CDK4/6i compared to paclitaxel cohort: TTF 17.3 vs. 3.5 months (HR 0.33, 95%CI 0.17–0.61, p = 0.0002), PFS 17.8 vs. 4.5 months (HR 0.38, 95%CI 0.21–0.67, p = 0.002), OS 24.6 vs. 6.7 months (HR 0.37, 95%CI 0.20–0.68, p = 0.002). The median time to first improvement in IVC/VC was similar in patients receiving CDK4/6i compared to paclitaxel (3.9 vs. 3.6 weeks, p = 0.773). Disease control at 4 months was not significantly different in the CDK4/6i and paclitaxel cohorts (77.8% vs. 59.4%, p = 0.168). In multivariate analysis, treatment with CDK4/6i was independently associated with a longer PFS compared to paclitaxel (HR 0.31, 95%CI 0.12–0.78, p = 0.015). Conclusion In this retrospective study, patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i had a significantly better survival compared to those treated with weekly paclitaxel. Further prospective studies that minimise possible selection bias are recommended.

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The efficacy and safety of paclitaxel plus bevacizumab therapy in breast cancer patients with visceral crisis

Cited by 6 publications

References 20 publications

Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Clinical Review on the Management of Breast Cancer Visceral Crisis

CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2- advanced breast cancer with impending or established visceral crisis

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