Metastatic Breast Cancer: How Much Chemotherapy is Enough?

This woman is being treated with docetaxel for...
(Photo credit: Wikipedia)

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.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: J Clin Oncol 2013;31:1732.

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