Abstract
Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.
Highlights
Breast cancer is the most common malignancy and the second leading cause of cancerrelated death among women worldwide [1]
Thirteen (3.4%) patients had central nervous system (CNS) metastases, which were previously treated with whole-brain palliative irradiation and were neurologically stable before enrolment
Clinical outcome was better with maintenance gery of the primary tumor, or metastasectomy or radiation therapy, and were excluded treatment with BEV with or without ET in terms of progressionfree survival (PFS) [20.3 (95% C.I: 15.5–25.1) versus from treatment analysis
Summary
Breast cancer is the most common malignancy and the second leading cause of cancerrelated death among women worldwide [1]. Over the past two decades, an improvement in overall survival of breast cancer patients has been noticed. Despite these advances, metastatic breast cancer (mBC) remains a rarely curable disease with a median overall survival (OS) of 24–36 months for the human epidermal growth factor receptor 2 (HER2)negative subset of patients. Over the past 20 years, treatment has evolved to a more target-directed approach based on the better characterization of the biological underpinnings of breast cancer, and the major pathways involved in tumor progression and metastasis. Angiogenesis is one of the hallmarks of cancer and vascular endothelial growth factor (VEGF) is the major regulator of angiogenesis in normal and malignant tissues [2,3]
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