title: Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer.
abstract: BACKGROUND
  Resistance to endocrine therapy in breast cancer is associated with activation of the mammalian target of rapamycin (mTOR) intracellular signaling pathway. In early studies, the mTOR inhibitor everolimus added to endocrine therapy showed antitumor activity.
  
  
  METHODS
  In this phase 3, randomized trial, we compared everolimus and exemestane versus exemestane and placebo (randomly assigned in a 2:1 ratio) in 724 patients with hormone-receptor-positive advanced breast cancer who had recurrence or progression while receiving previous therapy with a nonsteroidal aromatase inhibitor in the adjuvant setting or to treat advanced disease (or both). The primary end point was progression-free survival. Secondary end points included survival, response rate, and safety. A preplanned interim analysis was performed by an independent data and safety monitoring committee after 359 progression-free survival events were observed.
  
  
  RESULTS
  Baseline characteristics were well balanced between the two study groups. The median age was 62 years, 56% had visceral involvement, and 84% had hormone-sensitive disease. Previous therapy included letrozole or anastrozole (100%), tamoxifen (48%), fulvestrant (16%), and chemotherapy (68%). The most common grade 3 or 4 adverse events were stomatitis (8% in the everolimus-plus-exemestane group vs. 1% in the placebo-plus-exemestane group), anemia (6% vs. <1%), dyspnea (4% vs. 1%), hyperglycemia (4% vs. <1%), fatigue (4% vs. 1%), and pneumonitis (3% vs. 0%). At the interim analysis, median progression-free survival was 6.9 months with everolimus plus exemestane and 2.8 months with placebo plus exemestane, according to assessments by local investigators (hazard ratio for progression or death, 0.43; 95% confidence interval [CI], 0.35 to 0.54; P<0.001). Median progression-free survival was 10.6 months and 4.1 months, respectively, according to central assessment (hazard ratio, 0.36; 95% CI, 0.27 to 0.47; P<0.001).
  
  
  CONCLUSIONS
  Everolimus combined with an aromatase inhibitor improved progression-free survival in patients with hormone-receptor-positive advanced breast cancer previously treated with nonsteroidal aromatase inhibitors. (Funded by Novartis; BOLERO-2 ClinicalTrials.gov number, NCT00863655.).
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA. jbaselga@partners.org
authors.forename: José
authors.initials: J
authors.lastname: Baselga
authors.forename: Mario
authors.initials: M
authors.lastname: Campone
authors.forename: Martine
authors.initials: M
authors.lastname: Piccart
authors.forename: Howard A
authors.initials: HA
authors.lastname: Burris
authors.forename: Hope S
authors.initials: HS
authors.lastname: Rugo
authors.forename: Tarek
authors.initials: T
authors.lastname: Sahmoud
authors.forename: Shinzaburo
authors.initials: S
authors.lastname: Noguchi
authors.forename: Michael
authors.initials: M
authors.lastname: Gnant
authors.forename: Kathleen I
authors.initials: KI
authors.lastname: Pritchard
authors.forename: Fabienne
authors.initials: F
authors.lastname: Lebrun
authors.forename: J Thaddeus
authors.initials: JT
authors.lastname: Beck
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Denise
authors.initials: D
authors.lastname: Yardley
authors.forename: Ines
authors.initials: I
authors.lastname: Deleu
authors.forename: Alejandra
authors.initials: A
authors.lastname: Perez
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachelot
authors.forename: Luc
authors.initials: L
authors.lastname: Vittori
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Xu
authors.forename: Pabak
authors.initials: P
authors.lastname: Mukhopadhyay
authors.forename: David
authors.initials: D
authors.lastname: Lebwohl
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy*; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000032:analysis; D000068338:Everolimus; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D017698:Postmenopause; D012008:Recurrence; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013280:Stomatitis / Q000139:chemically induced; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D000068338:Everolimus; C546842:MTOR protein, human; D066246:ErbB Receptors; D058570:TOR Serine-Threonine Kinases; C056516:exemestane; D020123:Sirolimus