Endocrine-based therapy versus chemotherapy in advanced breast cancer
Mené en Corée sur 184 patientes atteintes d'un cancer du sein HR+ HER2- de stade métastatique avant la méopause, cet essai de phase II compare l'efficacité, du point de vue de la survie sans progression, et la toxicité d'une chimiothérapie par capécitabine et d'un traitement combinant palbociclib, exémestane et suppression de la fonction ovarienne
Approximately 70% of metastatic breast cancers are oestrogen receptor-positive and HER2-negative. International guidelines recommend endocrine therapy as a preferred first-line treatment for oestrogen receptor-positive, HER2-negative metastatic breast cancer, “even in the presence of visceral disease, unless there is a visceral crisis or concern or proof of endocrine resistance”. However, several studies have reported that 35–60% of patients in Europe and North America receive chemotherapy as first-line treatment, especially younger patients and those with visceral disease, even though a retrospective study suggested worse outcomes for patients treated with chemotherapy than those treated with endocrine therapy. Several reasons potentially explain low adherence to international guidelines, but one major reason has been the absence of evidence from randomised trials comparing endocrine treatment with chemotherapy in the first-line setting.
The Lancet Oncology , commentaire, 2018