Health-related quality of life and disease symptoms in postmenopausal women with HR+, HER2− advanced breast cancer treated with everolimus plus exemestane versus exemestane monotherapy

• Published in: Current medical research and opinion 2013-11, Vol.29 (11), p.1463-1473
• Main Authors: Campone, Mario, Beck, J. Thaddeus, Gnant, Michael, Neven, Patrick, Pritchard, Kathleen I., Bachelot, Thomas, Provencher, Louise, Rugo, Hope S., Piccart, Martine, Hortobagyi, Gabriel N., Nunzi, Martina, Heng, Daniel Y.C., Baselga, José, Komorowski, Anna, Noguchi, Shinzaburo, Horiguchi, Jun, Bennett, Lee, Ziemiecki, Ryan, Zhang, Jie, Cahana, Ayelet, Taran, Tetiana, Sahmoud, Tarek, Burris, Howard A.
• Format: Article
• Language: English
• Subjects: Adult; Advanced breast cancer; Aged; Androstadienes - adverse effects; Androstadienes - therapeutic use; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast Neoplasms - drug therapy; Breast Neoplasms - metabolism; Disease Progression; Disease-Free Survival; Everolimus; Exemestane; Female; Gynecology. Andrology. Obstetrics; Health Status; Health-related quality of life; Hormone receptor positive; Humans; Immunosuppressive Agents - therapeutic use; Mammary gland diseases; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Pharmacology. Drug treatments; Placebos - therapeutic use; Quality of Life; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - metabolism; Receptors, Progesterone - metabolism; Sirolimus - adverse effects; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; Surveys and Questionnaires; Treatment Outcome; Tumors
• ISSN: 0300-7995; 1473-4877
• DOI: 10.1185/03007995.2013.836078

Abstract Objective: Everolimus (EVE)+exemestane (EXE; n = 485) more than doubled median progression-free survival versus placebo (PBO) + EXE (n = 239), with a manageable safety profile and no deterioration in health-related quality-of-life (HRQOL) in patients with hormone-receptor-positive (HR+) advanced breast cancer (ABC) who recurred or progressed on/after nonsteroidal aromatase inhibitor (NSAI) therapy. To further evaluate EVE + EXE impact on disease burden, we conducted additional post-hoc analyses of patient-reported HRQOL. Research design and methods: HRQOL was assessed using EORTC QLQ-C30 and QLQ-BR23 questionnaires at baseline and every 6 weeks thereafter until treatment discontinuation because of disease progression, toxicity, or consent withdrawal. Endpoints included the QLQ-C30 Global Health Status (QL2) scale, the QLQ-BR23 breast symptom (BRBS), and arm symptom (BRAS) scales. Between-group differences in change from baseline were assessed using linear mixed models with selected covariates. Sensitivity analysis using pattern-mixture models determined the effect of study discontinuation on/before week 24. Treatment arms were compared using differences of least squares mean (LSM) changes from baseline and 95% confidence intervals (CIs) at each timepoint and overall. Clinical trial registration: Clinicaltrials.gov: NCT00863655. Main outcome measures: Progression-free survival, survival, response rate, safety, and HRQOL. Results: Linear mixed models (primary model) demonstrated no statistically significant overall difference between EVE + EXE and PBO + EXE for QL2 (LSM difference = −1.91; 95% CI = −4.61, 0.78), BRBS (LSM difference = −0.18; 95% CI = −1.98, 1.62), or BRAS (LSM difference = −0.42; 95% CI = −2.94, 2.10). Based on pattern-mixture models, patients who dropped out early had worse QL2 decline on both treatments. In the expanded pattern-mixture model, EVE + EXE-treated patients who did not drop out early had stable BRBS and BRAS relative to PBO + EXE. Key limitations: HRQOL data were not collected after disease progression. Conclusions: These analyses confirm that EVE + EXE provides clinical benefit without adversely impacting HRQOL in patients with HR+ ABC who recurred/progressed on prior NSAIs versus endocrine therapy alone.