Bottom Line: Maintenance therapy for metastatic breast cancer prolongs survival, but increases hematologic (blood) toxicity.
The Study: Researchers conducted a prospective, randomized, multi center Phase III trial of 231 patients with metastatic breast cancer. The median age was 48. Patients who achieved disease control (complete response, partial response, or stable disease) after 6 cycles of first-line treatments with paclitaxel (Taxol) and gemcitabine (Gemzar) chemotherapy were then randomized to observation or maintenance chemotherapy until disease progression. Median follow-up was 33 months, and patients in the maintenance group received a median of 6 chemotherapy cycles.
Results: Median progression-free survival (PFS) was longer in the maintenance group (7.5 versus 3.8 months). However, the rate of hematologic toxicity (all severity levels) was higher in the maintenance group (87% versus 30%).
My take: The current study uses modern chemotherapy and shows a more convincing benefit (than previous studies) to maintenance chemotherapy. Increase in blood toxicity is the price, though. Whether to do maintenance chemotherapy is a shared decision between the patient and her care providers.
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Reference: J Clin Oncol 2013;31:1732.