Raadpleeg ook de literatuurlijsten niet-toxische middelen en behandelingen specifiek bij borstkanker van arts-bioloog drs. Engelbert Valstar

30 juni 2020: lees ook dit artikel: https://kanker-actueel.nl/NL/circulerend-tumor-dna-in-bloed-bij-start-van-behandeling-met-fulvestrant-met-of-zonder-palbociclib-geeft-aanwijzingen-voor-prognose-op-aanslaan-van-de-behandeling-bij-patienten-met-uitgezaaide-borstkanker.html

16 april 2019: Bron: N Engl J Med 2019; 380:1226-1234

Het is al langer praktijk zover ik weet maar de combinatie van femara - anastrozole met fulvestrand geeft een betere overall overleving dan femara - anastrozole alleen bij borstkankerpatienten met uitgezaaide borstkanker met hormoongevoelige tumoren. De combinatie geeft een verbetering van de mediane overall overleving met 8 maanden (5 procent).

De kernpunten uit de studie (NCT00075764.):

De auteurs van deze studie analyseerden de overlevingsresultaten van 694 postmenopauzale patiënten met hormoongevoelige uitgezaaide borstkanker die gerandomiseerd waren ingedeeld om of de aromataseremmer anastrozol - femara plus fulvestrant te krijgen. Of alleen femara - anastrozol als eerstelijns therapie.
De combinatiegroep van anastrozole - femara met fulvestrand had 247 sterfgevallen onder 349 vrouwen (71%), met een mediane totale overleving van 49,8 maanden. Onder de vrouwen die alleen femara - anastrozol hadden gehad, waren er 261 sterfgevallen onder 345 vrouwen (76%), met een mediane totale overleving van 42.0 maanden. Het verschil tussen de twee groepen was statistisch significant (HR, voor overlijden 0,82; P = 0,03).
De toevoeging van fulvestrant aan femara - anastrozol blijkt geassocieerd met een verbetering van de overleving op de lange termijn.

Het volledige studierapport: Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer is tegen betaling in te zien.

Hier het abstract van de studie:

March 28, 2019
N Engl J Med 2019; 380:1226-1234
DOI: 10.1056/NEJMoa1811714

Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer

Rita S. Mehta, M.D.,
William E. Barlow, Ph.D.,
Kathy S. Albain, M.D.,
Ted A. Vandenberg, M.D.,
Shaker R. Dakhil, M.D.,
Nagendra R. Tirumali, M.D.,
Danika L. Lew, M.A.,
Daniel F. Hayes, M.D.,
Julie R. Gralow, M.D.,
Hannah H. Linden, M.D.,
Robert B. Livingston, M.D.,
and Gabriel N. Hortobagyi, M.D.

Abstract

Background

We previously reported prolonged progression-free survival and marginally prolonged overall survival among postmenopausal patients with hormone receptor–positive metastatic breast cancer who had been randomly assigned to receive the aromatase inhibitor anastrozole plus the selective estrogen-receptor down-regulator fulvestrant, as compared with anastrozole alone, as first-line therapy. We now report final survival outcomes.

Methods

We randomly assigned patients to receive either anastrozole or fulvestrant plus anastrozole. Randomization was stratified according to adjuvant tamoxifen use. Analysis of survival was performed by means of two-sided stratified log-rank tests and Cox regression. Efficacy and safety were compared between the two groups, both overall and in subgroups.

Results

Of 707 patients who had undergone randomization, 694 had data available for analysis. The combination-therapy group had 247 deaths among 349 women (71%) and a median overall survival of 49.8 months, as compared with 261 deaths among 345 women (76%) and a median overall survival of 42.0 months in the anastrozole-alone group, a significant difference (hazard ratio for death, 0.82; 95% confidence interval , 0.69 to 0.98; P=0.03 by the log-rank test). In a subgroup analysis of the two strata, overall survival among women who had not received tamoxifen previously was longer with the combination therapy than with anastrozole alone (median, 52.2 months and 40.3 months, respectively; hazard ratio, 0.73; 95% CI, 0.58 to 0.92); among women who had received tamoxifen previously, overall survival was similar in the two groups (median, 48.2 months and 43.5 months, respectively; hazard ratio, 0.97; 95% CI, 0.74 to 1.27) (P=0.09 for interaction). The incidence of long-term toxic effects of grade 3 to 5 was similar in the two groups. Approximately 45% of the patients in the anastrozole-alone group crossed over to receive fulvestrant.

Conclusions

The addition of fulvestrant to anastrozole was associated with increased long-term survival as compared with anastrozole alone, despite substantial crossover to fulvestrant after progression during therapy with anastrozole alone. The results suggest that the benefit was particularly notable in patients without previous exposure to adjuvant endocrine therapy. (Funded by the National Cancer Institute and AstraZeneca; ClinicalTrials.gov number, NCT00075764.)

fulvestrand, femara, anastrozole, overall overleving, hormoongevoelige borstkanker