ORLANDOWith an ever-expanding list of active agents for metastatic
breast cancer and even more potential combinations, choosing the best
therapy for each patient can be a challenge, according to Clifford Hudis,
MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering
Cancer Center. But Dr. Hudis makes a case for weighting the decision toward
single-agent sequential therapy and for keeping quality of life at the
forefront of the decision-making process.
Speaking at an industry-sponsored symposium held in conjunction with the
38th Annual Meeting of the American Society of Clinical Oncology, Dr. Hudis
prefaced his discussion with a question often asked by patients: "If we
can’t cure metastatic breast cancer, why do we treat it with chemotherapy,
with all its side effects, both large and small?"
The answer, he said, is that "we know we can palliate breast cancer.
In some cases, we can prolong survival, and that’s always remarkable when
we see it. In many cases, we can show prolonged time to progression, which
does, I believe, map to quality-of-life improvements. But quality of life
really is the bottom line."
The approach to palliation of any metastatic cancer is twofold, he said.
"You reduce tumor burden, but at the same time, you have to be very
cognizant of any negative effect on quality of life that the treatment may
cause."
With these assertions as a backdrop, Dr. Hudis reviewed the "largely
overlapping first-line activity" of commonly used agents. He suggested
that using response as the sole arbiter of benefit may not be the most
optimal approach and that the order in which these agents are applied as
first-, second-, or third-line therapy may not make a significant
difference.
Moreover, he maintained that in many instances sequential therapy can be
a better choice than combination therapy.
Dr. Hudis cited several studies of combination vs single-agent therapies
in which the combinations were slightly more active in terms of response
rate but showed no statistically significant effect on time to progression
or overall survival. Quality of life, however, was better with single-agent
regimens, he said.