title: Continuing chemotherapy or not after the induction treatment in advanced breast cancer patients. clinical outcomes and oncologists' preferences.
abstract: The optimal duration of cytostatic treatment for metastatic breast cancer is still a matter of debate. Possible gain in the duration of remission has to be weighed against the side-effects of treatment. Our aim was to define the optimal duration of cyclophosphamide, methotrexate, 5-fluorouracil (CMF) treatment by studying the time to treatment failure, overall survival and using a Q-TWiST analysis. The treating physician's opinion was asked. The European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer Group conducted a randomised trial in 204 non-progressing metastatic breast cancer patients after induction chemotherapy (CMF) to stop or continue treatment. Progression-free (PFS) and overall survival (OS) were studied. To gain more insight into the burden of treatment-related side-effects, Q-TWiST was analysed. In addition, we asked for oncologists' preferences as patients are likely to be influenced by their physicians' opinion. Continuation of CMF had a significantly longer time to treatment failure (TTF) 5.2 versus 3.5 months (P=0.011). There was no overall survival (OS) difference 14.0 versus 14.4 months (P=0.77). Mean quality-adjusted survival time was equal to 8.4 months for no further treatment and decreased to 7.9 months for continuation of CMF (95% Confidence Interval (CI) of difference equals 0.5+/-2.5 months). Almost half of the oncologists said they would favour continuous treatment for a 3-month gain in time to progression-a difference which was not found in this study. Based on these data, an interruption of chemotherapy (CMF), if this is the wish of the patient, is justified.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, The Netherlands. manooij@lumc.nl
authors.forename: M A
authors.initials: MA
authors.lastname: Nooij
authors.forename: J C J M
authors.initials: JC
authors.lastname: de Haes
authors.forename: L V A M
authors.initials: LV
authors.lastname: Beex
authors.forename: J
authors.initials: J
authors.lastname: Wildiers
authors.forename: J
authors.initials: J
authors.lastname: Klijn
authors.forename: D
authors.initials: D
authors.lastname: Becquart
authors.forename: J
authors.initials: J
authors.lastname: Jassem
authors.forename: E
authors.initials: E
authors.lastname: Engelsman
authors.forename: L
authors.initials: L
authors.lastname: Duchateau
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate