Abstract
Endocrine therapy is the preferred option for patients with hormone receptor-positive, HER2-negative advanced or metastatic breast cancer. 1 Gennari A André F Barrios CH et al. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021; 32: 1475-1495 Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar However, first-line chemotherapy is used in approximately half of this patient population, notably in the context of organ failure or resistance to endocrine therapy. 2 Werutsky G Reinert T Rosa ML Barrios CH Real-world data on first-line systemic therapy for hormone receptor-positive HER2-negative metastatic breast cancer: a trend shift in the era of CDK 4/6 inhibitors. Clin Breast Cancer. 2021; 21: e688-e692 Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 3 Jacquet E Lardy-Cléaud A Pistilli B et al. Endocrine therapy or chemotherapy as first-line therapy in hormone receptor-positive HER2-negative metastatic breast cancer patients. Eur J Cancer. 2018; 95: 93-101 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar In these patients, chemotherapy is frequently stopped, despite disease stabilisation, because of acute and cumulative toxic effects. 4 Giuliano M Schettini F Rognoni C et al. Endocrine treatment versus chemotherapy in postmenopausal women with hormone receptor-positive, HER2-negative, metastatic breast cancer: a systematic review and network meta-analysis. Lancet Oncol. 2019; 20: 1360-1369 Summary Full Text Full Text PDF PubMed Scopus (66) Google Scholar Switching to maintenance endocrine therapy after first-line induction chemotherapy has been proposed to improve disease control and to maintain quality of life (QOL). Switch maintenance therapy is regularly used in clinical practice, 1 Gennari A André F Barrios CH et al. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021; 32: 1475-1495 Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 3 Jacquet E Lardy-Cléaud A Pistilli B et al. Endocrine therapy or chemotherapy as first-line therapy in hormone receptor-positive HER2-negative metastatic breast cancer patients. Eur J Cancer. 2018; 95: 93-101 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar although clinical trials attesting to its relevance are scarce. 5 Ren W Yu Y Hong H et al. Clinical evidence of chemotherapy or endocrine therapy maintenance in patients with metastatic breast cancer: meta-analysis from randomized clinical trials and propensity score matching of multicentre cohort study. Cancer Res Treat. 2022; (published online Feb 4.)https://doi.org/10.4143/crt.2021.698 Crossref PubMed Google Scholar Moreover, the first-line combination of bevacizumab (an anti-angiogenic monoclonal antibody) plus chemotherapy has been shown in clinical trials to improve progression-free survival, although its effect on overall survival remains controversial. 6 Miyashita M Hattori M Takano T Toyama T Iwata H Risks and benefits of bevacizumab combined with chemotherapy for advanced or metastatic breast cancer: a meta-analysis of randomized controlled trials. Breast Cancer. 2020; 27: 347-354 Crossref PubMed Scopus (7) Google Scholar These results have led to the consideration of this combination as an acceptable first-line strategy. 1 Gennari A André F Barrios CH et al. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021; 32: 1475-1495 Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Similarly, bevacizumab plus endocrine therapy is efficacious in improving progression-free survival and overall survival while being well tolerated as a first-line treatment for advanced or metastatic breast cancer. 7 Martín M Loibl S Hyslop T et al. Evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for hormone receptor-positive metastatic breast cancer: a pooled analysis from the LEA (GEICAM/2006–11_GBG51) and CALGB 40503 (Alliance) trials. Eur J Cancer. 2019; 117: 91-98 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Switch maintenance endocrine therapy plus bevacizumab after bevacizumab plus paclitaxel in advanced or metastatic oestrogen receptor-positive, HER2-negative breast cancer (BOOSTER): a randomised, open-label, phase 2 trialSwitch to maintenance endocrine therapy plus bevacizumab with the possibility of weekly paclitaxel reinduction if needed is an efficacious alternative, with a better safety profile, to continuing weekly paclitaxel plus bevacizumab in patients with ER-positive, HER2-negative advanced or metastatic breast cancer who have responded to induction therapy. Full-Text PDF
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