ABSTRACT
BACKGROUND: Recent UK clinical guidance advises against continuing trastuzumab (T) beyond disease progression (PD) in the absence of brain metastases in patients with HER-2 positive (+ve) advanced breast cancer .We have retrospectively evaluated the outcome of patients with HER-2+ve locally advanced (LA) or metastatic breast cancer (MBC) who continued T beyond PD, treated in our unit. METHODS: All HER-2+ve patients on our prospectively maintained database with LA or MBC who received T beyond PD after adjuvant or one line of T for advanced disease were assessed for response and outcome. From the timepoint of T continuation beyond PD, we calculated the overall disease control rate, time to progression (TTP), and overall survival (OS). RESULTS: One hundred and fourteen patients with HER-2+ve LA or MBC treated with T beyond PD were identified. The main site of disease was visceral in 84 (74%) patients. Seventy-six (66%) had one line of chemotherapy before continuation of T beyond PD and 21 (19%) had two or more. Post-progression, 66 (58%) received T combined with chemotherapy. Of the 93 (82%) patients with documented clinical or radiological response evaluation, 67 (59%) were considered as having stable disease or better. The median TTP was 24 weeks (95% CI: 21-28) and the median OS was 19 months (95% CI: 12-24). CONCLUSION: Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , Genes, erbB-2 , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Brain Neoplasms/secondary , Breast Neoplasms/genetics , Disease Progression , Female , Humans , Middle Aged , Retrospective Studies , TrastuzumabABSTRACT
Single agent capecitabine is effective and well tolerated in metastatic breast cancer (MBC). We have retrospectively analysed capecitabine outcome as 1st, 2nd or 3rd line chemotherapy in 89 elderly patients ≥70 years with locally advanced or MBC treated in our Unit, 55 (62%) as 1st line and 34 (38%) as 2nd or 3rd line. Starting dose was 1000 mg/m(2) twice daily, days 1-14 every 3 weeks, but 36 (41%) started on a 25% dose reduction because of frailty and 12 (13%) reduced dose after the 1st or the 2nd cycle. Overall response rate (ORR) was 45% (95% CI: 35-55%). A further 19 (21%) achieved stable disease (SD) for ≥6 months. Median time to progression (TTP) and overall survival (OS) were 30 (95% CI: 23-37) and 61 (95% CI: 44-77) weeks, respectively. The ORR for 1st line treatment was 51% compared with 35% for 2nd and 3rd line treatment (p = 0.03). No significant difference in efficacy was seen between patients receiving the full versus reduced dose. Capecitabine was well tolerated, although 35% had treatment delays and 57% required dose reduction. Grade 3-4 toxicities were hand-foot syndrome in 11%, lethargy 9% and diarrhoea 2%. Capecitabine is an effective and well-tolerated drug in elderly patients with MBC including for 1st line treatment. Dose reduction is frequently required but does not appear to affect outcome.
Subject(s)
Antimetabolites, Antineoplastic/administration & dosage , Breast Neoplasms/drug therapy , Deoxycytidine/analogs & derivatives , Fluorouracil/analogs & derivatives , Aged , Aged, 80 and over , Antimetabolites, Antineoplastic/adverse effects , Antimetabolites, Antineoplastic/therapeutic use , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Capecitabine , Deoxycytidine/administration & dosage , Deoxycytidine/adverse effects , Deoxycytidine/therapeutic use , Disease Progression , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Fluorouracil/therapeutic use , Humans , Kaplan-Meier Estimate , Neoplasm Metastasis , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Recent data suggest that capecitabine may have little efficacy in women with metastatic triple negative breast cancer (TNT). We have therefore retrospectively analysed capecitabine outcome in the TN subgroup of patients with locally advanced or metastatic breast cancer treated in our unit. PATIENTS AND METHODS: All TNT patients on our prospectively maintained database with locally advanced or metastatic breast cancer who were given capecitabine as 1st-, 2nd- or 3rd-line chemotherapy were assessed for response and outcome. RESULTS: In total, 363 patients with locally advanced or metastatic breast cancer treated with capecitabine were identified. Eighty-nine (24.5%) patients had TNT and of these, 47 (53%) patients received capecitabine as 1st-line treatment and 42 (47%) as 2nd- or 3rd-line treatment. The overall response rate was 21% (95% CI: 13-31%), including 1 (1%) complete response (CR) and 18 (20%) partial responses (PR). Another 11 (12%) patients maintained stable disease (SD) for 6 months. An overall disease control (CR + PR + SD) was, therefore, achieved in 30 (33%) patients. The median time to disease progression was 11 weeks (95% CI: 9-13) and the median overall survival was 39 weeks (95% CI: 33-45). Median response duration was 22 weeks (95% CI: 18-25). No significant difference in efficacy was seen between 1st- and 2nd-/3rd-line treatment. CONCLUSION: Capecitabine is a treatment option for patients with TN tumours in advanced disease including 1st line and 2nd/3rd line.
Subject(s)
Breast Neoplasms/drug therapy , Deoxycytidine/analogs & derivatives , Fluorouracil/analogs & derivatives , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Adult , Aged , Aged, 80 and over , Breast Neoplasms/chemistry , Capecitabine , Deoxycytidine/therapeutic use , Female , Fluorouracil/therapeutic use , Humans , Middle Aged , Treatment OutcomeABSTRACT
The aim of this study is to validate the 'Comprehensive Assessment of Satisfaction with Care' (CASC) in Greece. A total of 84 cancer inpatients met the inclusion criteria. Of them, 32 (38%) refused to participate, leading to a 62% response rate. For the translation of the scale, we followed the European Social Survey procedures encompassing four stages. Interview-based administration was chosen in order to obtain more reliable results in terms of time of assessment, response rate and data omission. Multitrait scaling analyses along with construct, scale-discriminant validity and reliability tests were carried out to establish the Greek version of CASC. Scales on doctors' technical skills, care organization and general satisfaction were in support of the European structure. In general, Doctors' scales had the anticipated structures. Most variations were noticed in the Nurses' scales, leading to a revised item-scale formation, and may reflect different importance patients attribute to various aspects of health care in different countries. Greek version of CASC may be a practical, valid and reliable tool for assessing patient satisfaction in oncology settings. Cross-cultural validation of the existing tools is necessary to enable comparison between various countries and settings. Interview-based administration should be considered when validating patient satisfaction instruments.
