Maintenance Taxol Does Not Improve Survival in Metastatic Breast Cancer

CancerConsultants.com

Researchers from Spain affiliated with the TASMAN clinical trial have reported that maintenance Taxol (paclitaxel) administered after induction with Taxol and Ellence (epirubicin) does not improve progression-free survival. The details of this study were presented at the 2009 meeting of the American Society of Clinical Oncology in May/June.[1]

The role of maintenance therapy in women with metastatic breast cancer is unresolved. Over the past one or two decades the concept of maintenance chemotherapy has fallen out of favor due to concern about toxicity and the development of chemotherapy resistance and compromising second-line salvage therapy. Most patients with metastatic breast cancer probably do not receive maintenance chemotherapy. However, there has been recent revived interest in maintenance therapy with the development of targeted agents and monoclonal antibodies where toxicity and resistance concerns are less of a problem.

There has also been recent interest in continuous (metronomic) administration of Adriamycin (doxorubicin), cyclophosphamide, and Taxol (AC-P) for the treatment of breast cancer. Metronomic administration allows for lower doses of therapy to be administered without a prolonged drug-free break with lower toxicities. Laboratory analysis has indicated that metronomic administration may enhance apoptotic effects of therapy, and trials continue to evaluate the efficacy of this approach. However, researchers from Canada have reported that the use of low-dose Taxotere (docetaxel) on a weekly basis plus Xeloda (capecitabine) on a daily basis provided benefit for a significant portion of patients with anthracycline-refractory metastatic breast cancer (see related news). This approach has not been extensively evaluated as a maintenance strategy.

The current study involved 180 women with metastatic breast cancer who received three courses of Ellence followed by three courses of Taxol administered every 21 days. Patients were randomly allocated to receive no further therapy or maintenance Taxol administered every week until disease progression.

• Median progression-free survival was 8 months for the no-maintenance group and 12 months for the maintenance group.
• Median overall survival was 24 months for both arms of the study.

These authors concluded that weekly Taxol maintenance did not improve outcome of patients with metastatic breast cancer.

Comments: There will undoubtedly be other studies of different maintenance strategies involving targeted agents, monoclonal antibodies or metronomic strategies in women with metastatic breast cancer.

Reference:

[1] Mayodomo JI, Abena JM, Cirera L, et al. Final results of a randomized trial on the role of maintenance chemotherapy with weekly paclitaxel for patients with metastatic breast cancer. Journal of Clinical Oncology 2009;27:15s, (Supplement;abstract 1001).


© 1998-2007 OncoEd.com All Rights Reserved.