A systematic review of taxane-containing regimens for metastatic breast cancer

We compared the results of randomised trials comparing taxane-containing chemotherapy regimens with regimens not containing a taxane in women with metastatic breast cancer. The specialised register of the Cochrane Breast Cancer Group was searched in March 2004. Eligibility was assessed and data extracted from eligible studies by two reviewers. Hazard ratios (HR) were derived for time-to-event outcomes, and a fixed-effect model was used for meta-analysis. Tumour response rates were analysed as dichotomous variables. Of 21 eligible trials, 16 had published some results and 12 data on overall survival. An estimated 2621 deaths among 3643 women suggest a significant difference in overall survival in favour of taxane-containing regimens (HR 0.93, 95% confidence interval (CI) 0.86-1.00, P=0.05). The treatment effect on survival was similar if only trials of first-line chemotherapy were included, although not statistically significant. There appeared to be an advantage for taxanes in time to progression (HR 0.92, 95% CI 0.85-0.99, P=0.02) and overall response (odds ratio (OR) 1.34, 95% CI 1.18-1.52, P<0.001). There was significant heterogeneity across the trials (P<0.001), partly because of the varying efficacy of the comparator regimens. Taxane-containing regimens improved overall survival in women with metastatic breast cancer. Taxane-containing regimens are more effective than some, but not all, nontaxane-containing regimens.     

A qualitative systematic review of the evidence base for non-cross-resistance between steroidal and non-steroidal aromatase inhibitors in metastatic breast cancer

Aims

The most effective sequence of tamoxifen and both steroidal (SAIs) and non-steroidal aromatase inhibitors (NSAIs) has been extensively studied in the adjuvant setting. However, treatments for women who have failed initial aromatase inhibitor therapy in the metastatic setting have received relatively little attention. A systematic review was undertaken to assess the use of SAIs and NSAIs in metastatic breast cancer.

Materials and methods

Medline, Embase and the Cochrane library were searched using free text and MeSH terms. Studies assessing the cross-resistance, efficacy and safety of SAIs and NSAIs for postmenopausal women with advanced metastatic breast cancer confirmed by histology/cytology were included. Patients had progressed/relapsed from previous adjuvant, first- or second-line aromatase inhibitor treatment and had undergone treatment with at least two regimens consisting of aminoglutethimide, anastrozole, letrozole and/or exemestane.

Results

Nine studies reported results for patients treated with an SAI after treatment failure with an NSAI. For SAI after NSAI, clinical benefit was the most frequently reported outcome. The clinical benefit for exemestane (SAI) after any NSAI failure or before treatment ranged from 12% (complete response not recorded, partial response 2%, stable disease 10%) to 55% (complete response 6%, partial response 13%, stable disease 35%) Survival outcomes were infrequently reported; four studies reported disease progression. The time to progression ranged from 3.7 to 5.2 months. Only one study reported a median overall survival with exemestane at 15.2 months. Only one study reported information for an NSAI after SAI and an NSAI followed by another NSAI.

Discussion

This review suggests that switching from an NSAI to an SAI is a reasonable option. This would be particularly important for patients who would probably respond to further endocrine manoeuvres; strongly oestrogen receptor-positive disease, non-visceral disease, a good prior response or a long duration of response. Further research to optimise the sequence of endocrine therapies in metastatic breast cancer is needed.     

A prospective evaluation of the durability of palliative interventions for patients with metastatic breast cancer

BACKGROUND:

Although systemic therapy for metastatic breast cancer (MBC) continues to evolve, there are scant data to guide physicians and patients when symptoms develop. In this article, the authors report the frequency and durability of palliative procedures performed in the setting of MBC.

METHODS:

From July 2002 to June 2003, 91 patients with MBC underwent 109 palliative procedures (operative, n = 76; IR n = 39, endoscopic n = 3). At study entry, patients had received a mean of 6 prior systemic therapies for metastatic disease. System‐specific symptoms included neurologic (33%), thoracic (23%), musculoskeletal (22%) and GI (14%). The most common procedures were thoracostomy with or without pleurodesis (27%), craniotomy with resection (19%) and orthopedic open reduction/internal fixation (19%).

RESULTS:

Symptom improvement at 30 days and 100 days was reported by 91% and 81% of patients, respectively, and 70% reported continued benefit for duration of life. At a median interval of 75 days from intervention (range, 8‐918 days), 23 patients (25%) underwent 61 additional procedures for recurrent symptoms. The durability of palliation varied with system‐specific symptoms. Patients with neurologic or musculoskeletal symptoms were least likely to require additional maintenance procedures (P < .0002). The 30‐day complication rate was 18% and there were no procedure‐related deaths. At a median survival of 37.4 mos from MBC diagnosis (range, 1.6‐164 months) and 8.4 months after intervention (range, 0.2‐73 months), 7 of 91 patients remained alive.

CONCLUSIONS:

Palliative interventions for symptoms of MBC are safe and provide symptom control for the duration of life in 70% of patients. Definitive surgical treatment of neurologic or musculoskeletal symptoms provided the most durable palliation; interventions for other symptoms frequently require subsequent procedures. The longer median survival for patients with MBC highlights the need to optimize symptom control to maintain quality of life. Cancer 2010. © 2010 American Cancer Society.     

Psychosocial interventions and quality of life in gynaecological cancer patients: a systematic review

Objective: Women with gynaecological cancer are at risk of poor quality of life outcomes. Although various psychosocial interventions have been developed to address these concerns, such interventions have not yet been systematically evaluated in this population. The current review provides an up‐to‐date and comprehensive summary of the evidence regarding the effectiveness of psychosocial interventions in women with gynaecological cancers. Methods: Relevant studies were identified via Medline, CINAHL, and PsycINFO databases (1980 to June 2008), reference lists of articles and reviews, grey literature databases, and consultations with physicians and other experts in the field. Only controlled trials comparing a psychosocial intervention with a control group in a gynaecological cancer population, with at least one quality of life variable as a main outcome, were included in the review. Two authors independently assessed trial quality and extracted data. Results: Twenty‐two studies involving 1926 participants were included. There was substantial variability in study quality and results. Evidence was mixed regarding intervention effects on social and sexual functioning, distress, depression, anxiety, attitude to medical care, self‐esteem and body image. Interventions generally did not improve physical or vocational outcomes. Conclusions: There was limited evidence in support of healing touch, whereas information‐based interventions seemed largely unable to provide meaningful benefits. Cognitive‐behavioural interventions had some positive effects. Counselling appeared to be the most promising intervention strategy for addressing quality of life concerns for women with gynaecological cancers. Copyright © 2008 John Wiley & Sons, Ltd.     

A systematic literature review of trials of survivorship interventions for women with gynaecological cancer and their caregivers

Core components of survivorship care include treatment of late and long‐term effects, care coordination, promotion of psychological well‐being, health and addressing special populations’ needs. Women affected by gynaecological cancer and their caregivers can experience disease‐specific issues. This review presents an overview of survivorship interventions that have been trialled among this population. Databases were searched in October/November 2016 to identify eligible studies. Titles, abstracts then full‐text were assessed for inclusion by two reviewers until consensus was reached. Data were abstracted using standard tables. Study quality was independently appraised. Twenty‐eight articles were included (five reviews; 23 trials). In regards to late and long‐term treatment effects, our review found mounting high‐level evidence for the effectiveness of psycho‐educational programmes to improve physical aspects of sexual function and for exercise interventions for reducing fatigue. We also found emerging evidence for nurse‐led follow‐up care to improve care coordination and cognitive behavioural therapy to improve psychological wellbeing. There were gaps in the evidence for interventions to effectively address psychosexual issues specific to gynaecological cancer and needs of caregivers. Further research is required to explore strategies to improving psychosexual concerns after gynaecological cancer and the dynamics and supportive care needs of the patient‐partner dyad.     

Psychological interventions with siblings of pediatric cancer patients: a systematic review

Objective: Siblings of pediatric cancer patients have been shown to be at risk for developing emotional, behavioral, and social problems. There is a need for psychological interventions in this population. Several researchers have previously documented and evaluated their interventions with siblings. This paper aimed at reviewing the existing reports of evaluated psychological interventions with siblings of pediatric cancer patients and at outlining future directions. Methods: Research was conducted on several online bibliographic databases. Articles were selected on the basis of predefined criteria. If possible, effect sizes (ES) were calculated. Results: Fourteen studies representing 11 different sibling interventions met criteria for inclusion. One individual intervention, three camps, and seven groups were found. Objectives of interventions concentrated mainly on enhancing siblings' coping and improving their medical knowledge. In terms of outcome measures, most of the studies focused on psychological adjustment variables. Findings showed significant improvements in siblings' depression symptomatology, medical knowledge, and health‐related quality of life. Findings were inconsistent with regard to anxiety, behavioral problems, social adjustment, self‐esteem, and posttraumatic stress symptoms. Depending on the outcome variables, small to large ES were found. Satisfaction with the intervention was high in both siblings and parents. Conclusion: There is tentative evidence that psychological interventions with siblings of childhood cancer patients can effectively reduce psychological maladjustment and improve medical knowledge about cancer. However, the number of studies is small, and several methodological shortcomings have to be noted. In future, more randomized controlled trials need to be conducted in larger samples to extend the evidence base. Copyright © 2009 John Wiley & Sons, Ltd.