AI Article Synopsis
- Two phase III trials were combined to assess the effectiveness of standard endocrine therapy (ET) versus ET plus bevacizumab (Bev) for hormone receptor-positive metastatic breast cancer patients.
- The addition of Bev improved progression-free survival (PFS) from 14.3 to 19 months, with higher objective response rates and clinical benefit rates, but did not affect overall survival (OS).
- However, patients receiving ET + Bev experienced significantly more severe side effects, including hypertension and proteinuria.
Article Abstract
Background: Randomised trials comparing the efficacy of standard endocrine therapy (ET) versus experimental ET + bevacizumab (Bev) in 1st line hormone receptor-positive patients with metastatic breast cancer have thus far shown conflicting results.
Patients And Methods: We pooled data from two similar phase III randomised trials of ET ± Bev (LEA and Cancer and Leukemia Group B 40503) to increase precision in estimating treatment effect. Primary end-point was progression-free survival (PFS). Secondary end-points were overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR) and safety. Exploratory analyses were performed within subgroups defined by patients with recurrent disease, de novo disease, prior endocrine sensitivity or resistance and reported grades III-IV hypertension and proteinuria.
Results: The pooled sample consisted of 749 patients randomised to ET or ET + Bev. Median PFS was 14.3 months for ET versus 19 months for ET + Bev (unadjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.66-0.91; p < 0.01). ORR and CBR with ET and ET + Bev were 40 versus 61% (p < 0.01) and 64 versus 77% (p < 0.01), respectively. There was no difference in OS (HR 0.96; 95% CI 0.77-1.18; p = 0.68). PFS was superior for ET + Bev for endocrine-sensitive patients (HR 0.68; 95% CI 0.53-0.89; p = 0.004). Grade III-IV hypertension (2.2 versus 20.1%), proteinuria (0 versus 9.3%), cardiovascular (0.5 versus 4.2%) and liver events (0 versus 2.9%) were significantly higher for ET + Bev (all p < 0.01). Hypertension and proteinuria were not predictors of efficacy (interaction test p = 0.33).
Conclusion: The addition of Bev to ET increased PFS overall and in endocrine-sensitive patients but not OS at the expense of significant additional toxicity.
Trials Registration: ClinicalTrial.Gov NCT00545077 and NCT00601900.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718694 | PMC |
| http://dx.doi.org/10.1016/j.ejca.2019.06.002 | DOI Listing |
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