Anthracycline rechallenge feasible with pegylated liposomal doxorubicin
MedWire News: Anthracycline rechallenge with pegylated liposomal doxorubicin (PLD) provides clinical benefit to nearly 40% of patients with metastatic breast cancer (MBC) who have previously received conventional anthracyclines, researchers report.
Furthermore, patients with a favorable Eastern Cooperative Group (ECOG) performance status at baseline are more likely to achieve clinical benefit than those with an unfavorable performance status.
"Because the majority of pretreated patients with MBC have been exposed to anthracyclines, either in the adjuvant or metastatic settings, there is a need for a cardiac tolerable and effective approach," explain Salah-Eddin Al-Batran (Krankenhaus Nordwest, Frankfurt am Main, Germany) and colleagues.
"Pegylated liposomal anthracycline formulations, such as PLD, represent an attractive option in this setting," they add.
To determine the efficacy of anthracycline rechallenge using PLD, Al-Batran and team reviewed pooled data from four prospective trials that included 274 women who had received PLD in the metastatic setting after prior exposure to conventional anthracyclines.
The researchers found that the overall clinical benefit rate (CBR) - defined as objective response, which included complete response, partial response or stable disease lasting longer than 6 months - from rechallenge with PLD was 37.2%.
ECOG performance status was the strongest predictor of clinical benefit; CBR was 53.3%, 35.5%, and 18.2% among patients with a baseline ECOG performance status of 0, 1, and 2, respectively, where 0 indicates an asymptomatic patient and 2 a symptomatic patient unable to carry out work activities.
CBR was also significantly higher in taxane-naive patients versus patients who received a previous taxane (53.0% vs 30.1%), and in patients with less exposure to prior chemotherapy (55.6% vs 24.6% vs 39.9% for one, two, and three prior therapies, respectively).
However, in multivariate analyses, only ECOG performance status was a significant independent predictor of the CBR achieved with PLD rechallenge.
Of note, there was no statistically significant difference in CBR regarding the setting, cumulative dose of and/or resistance to prior anthracyclines, or time since prior anthracycline administration.
"Given the characteristics of our population and that single-agent therapy was used, the overall CBR of 37% observed in our study is clinically meaningful and supports efficacy of an anthracycline rechallenge with PLD," Al-Batran and co-authors conclude in the British Journal of Cancer.
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By Laura Dean