Managing Metastatic Breast Cancer - Episode 2
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Determining the optimal second- and third-line therapy for patients with metastatic breast cancer (MBC) who become refractory to treatment is challenging, since varying evidence exists concerning each agent. As a result, the difficult decision facing many physicians is determining the most appropriate sequence.
Linda T. Vahdat, MD, explains that two antimicrotubule agents, eribulin mesylate (Halaven) and ixabepilone, have been studied in the late-line setting and have shown promising data. Vahdat notes that ixabepilone showed an increase in progression-free survival (PFS) but not in overall survival (OS) and eribulin demonstrated an increase in OS but not in PFS. Given the evidence from these trials, both of these agents have shown efficacy in later lines of therapy.
Christy A. Russell, MD, believes one of the major challenges facing all of these active agents is the occurrence of neuropathy and asks whether a better sequence needs to be discovered to help alleviate this side effect. Joyce A. O’Shaughnessy, MD, adds that several trials have investigated moving eribulin forward in the treatment landscape. Additionally, the agent irinotecan has shown promise and should also be considered following progression. O’Shaughnessy is optimistic regarding results from the phase III BEACON trial that is comparing the pegylated irinotecan conjugate NKTR-102 to physician’s choice for heavily pretreated women with MBC.
Moderator, Debu Tripathy, MD, questions the panel on the effectiveness of a trial design that compares an investigational agent to physician's choice, such as the BEACON trial. Russell likes this trial design but feels these agents should also be examined earlier in the treatment paradigm.