Improving the Management of Metastatic Breast Cancer, Part I

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Metastatic breast cancer (MBC) represents a challenging treatment landscape that has witnessed the approval of multiple new therapies, in recent years. Novel combinations of hormonal and targeted therapies are currently being explored as a possible treatment options in this difficult space.

Joyce A. O'Shaughnessy describes two frontline trials that recently examined anastrozole with or without fulvestrant for postmenopausal patients with MBC that was hormone receptor positive. The first, known as the FACT trial, did not find a clinical advantage for the combination. However, the second, SWOG 20226, found that the combination significantly prolonged both progression-free survival (PFS) and overall survival (OS).

When examining the patient population enrolled in the SWOG trial, O'Shaughnessy points out that more patients with de novo MBC were enrolled and overall fewer patients had received prior treatment with tamoxifen, when compared to the FACT trial. These differences may have resulted in the contradictory findings.

Other novel combinations have recently gained rapid approval from the FDA. Christy A. Russell, MD, describes results from the BOLERO-2 trial that examined the combination of everolimus and exemestane for postmenopausal women with estrogen receptor-positive MBC. The trial found a significant improvement in PFS with the combination. The challenge of this combination seems to be the unique side effects, one of which is stomatitis. O'Shaughnessy describes a prophylactic steroid mouth rinse, which she believes can effectively reduce the occurrence of stomatitis.

Linda T. Vahdat, MD, mentions several ongoing clinical trials combining PI3 kinase inhibitors with mTOR inhibitors for women with MBC. Additionally, she describes that trials are also looking at the agent abiraterone acetate for MBC. William J. Gradishar, MD, adds that other drugs approved for prostate cancer are also being examined in MBC, including enzalutamide and bicalutamide.

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