Τίτλος:
Specific Adverse Events Predict Survival Benefit in Patients Treated
With Tamoxifen or Aromatase Inhibitors: An International Tamoxifen
Exemestane Adjuvant Multinational Trial Analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Purpose
Specific adverse events (AEs) associated with endocrine therapy and
related to depletion or blocking of circulating estrogens may be related
to treatment efficacy. We investigated the relationship between survival
outcomes and specific AEs including vasomotor symptoms (VMSs),
musculoskeletal adverse events (MSAEs), and vulvovaginal symptoms (VVSs)
in postmenopausal patients with breast cancer participating in the
international Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial.
Patients and Methods
Primary efficacy end points were disease-free survival (DFS), overall
survival (OS), and distant metastases (DM). VMSs, MSAEs, and VVSs
arising in the first year of endocrine treatment were considered.
Patients who did not start or who discontinued their allocated therapy
and/or had an event (recurrence/death) within 1 year after randomization
were excluded. Landmark analyses and time-dependent multivariate Cox
proportional hazards models assessed survival differences up to 5 years
from the start of treatment.
Results
A total of 9,325 patients were included. Patients with specific AEs (v
nonspecific or no AEs) had better DFS and OS (multivariate hazard ratio
[HR] for DFS: VMSs, 0.731 [95% CI, 0.618 to 0.866]; MSAEs, 0.826
[95% CI, 0.694 to 0.982]; VVSs, 0.769 [95% CI, 0.585 to 1.01];
multivariate HR for OS: VMSs, 0.583 [95% CI, 0.424 to 0.803]; MSAEs,
0.811 [95% CI, 0.654 to 1.005]; VVSs, 0.570 [95% CI, 0.391 to
0.831]) and fewer DM (VMSs, 0.813 [95% CI, 0.664 to 0.996]; MSAEs,
0.749 [95% CI, 0.601 to 0.934]; VVSs, 0.687 [95% CI, 0.436 to
1.085]) than patients not reporting these symptoms. Increasing numbers
of specific AEs were also associated with better survival outcomes.
Outcomes were unrelated to treatment allocation.
Conclusion
Certain specific AEs are associated with superior survival outcomes and
may therefore be useful in predicting treatment responses in patients
with breast cancer treated with endocrine therapy. (C) 2013 by American
Society of Clinical Oncology
Συγγραφείς:
Fontein, Duveken B. Y.
Seynaeve, Caroline
Hadji, Peyman and
Hille, Elysee T. M.
de Water, Willemien van
Putter, Hein and
Kranenbarg, Elma Meershoek-Klein
Hasenburg, Annette
Paridaens,
Robert J.
Vannetzel, Jean-Michel
Markopoulos, Christos and
Hozumi, Yasuo
Bartlett, John M. S.
Jones, Stephen E.
Rea,
Daniel William
Nortier, Johan W. R.
van de Velde, Cornelis J. H.
Περιοδικό:
World Journal of Clinical Oncology
Εκδότης:
AMER SOC CLINICAL ONCOLOGY 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA
DOI:
10.1200/JCO.2012.45.3068
