https://vimeo.com/440626033
Results from the long-awaited E2108 trial showed that, in patients with metastatic breast cancer, local therapy did not improve overall survival (OS) when compared with optimal systemic therapy alone. The addition of locoregional therapy also failed to improve 3-year progression-free survival (PFS). However, recurrence or progression was significantly higher in the systemic arm alone.
With a median follow-up of 59 months, Prof. Seema Ahsan Khan (Feinberg School of Medicine, USA) presented the final follow-up data [1]. There has been a paucity of data about whether surgery and radiation to a breast tumour (local therapy) can prolong OS compared with systemic treatment alone. The goal of E2108 was to determine whether surgery and radiation should become routine practice for patients with stage IV breast cancer.
In total, 390 women with stage IV breast cancer were enrolled and received the optimal systemic treatment based on their tumour biomarker status and their metastatic profile. Of those whose disease responded to initial systemic therapy, 258 women were randomised to either receive continued systemic therapy or to receive surgery and radiation prior to continuing systemic therapy.
With 5 years follow-up, it was evident that there was no OS advantage for local therapy versus systemic therapy alone (68.4% vs 67.9%; HR 1.09; 90% CI 0.80-1.49; P=0.63). Furthermore, locoregional therapy did not improve 3-year PFS (P=0.40). In favour of local therapy, however, recurrence or progression was significantly higher in the systemic arm alone (25.6% vs 10.2%; P=0.003). Patient-reported quality of life, as measured by the FACT-B Trial Outcome Index to score depression, anxiety, and well-being, did not show any advantage for the locoregional therapy arm of the trial.
Prof. Khan compared the results to another trial: "When combined with the results of an earlier trial in Mumbai, India [2], these results tip the scales against the possibility that local therapy to the breast tumour will help women live longer." The Indian trial had a similar design to E2108, and also showed similar results between the two treatment groups.
She concluded: "Based on the results of our study, women who present with a new diagnosis of breast cancer already in stage IV should not be offered surgery and radiation for the primary breast tumour with the expectation of a survival benefit."
- Khan SA, et al. ASCO Virtual Meeting, 29-31 May 2020, Abstract LBA2.
- Badwe R, et al. Lancet Oncol. 2015;16(13):1380‐1388.
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Table of Contents: ASCO 2020
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Advanced breast cancer: locoregional therapy does not improve OS
T-DM1 does not improve safety or efficacy in HER-2 positive early breast cancer; favorable iDFS reported
Maintenance olaparib improves OS in relapsed ovarian cancer with BRCA1/2 mutation
Combination pembrolizumab/chemo improves PFS in metastatic TNBC
Effect of veliparib with or without cisplatin in breast cancer: results of SWOG S1416
PHOEBE, a phase 3 trial comparing pyrotinib and lapatinib in HER2-positive metastatic breast cancer
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Strategies emerge for chemotherapy de-escalation in HER2-positive breast cancer
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ES-SCLC: tremelimumab + durvalumab + chemotherapy misses endpoint
Adjuvant osimertinib in NSCLC: practice changing ADAURA trial
ES-SCLC: pembrolizumab KEYNOTE-604 data
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Tiragolumab and atezolizumab: ORR in NSCLC
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Urothelial cancer: avelumab works as maintenance therapy
ARAMIS final OS and nmCRPC safety outcomes
Final survival results from phase 3 SPARTAN trial
Novel drug for kidney cancers/VHL patients
Primary analysis from IMvigor010, adjuvant atezolizumab in high risk muscle-invasive urothelial carcinoma
First randomised trial of Lu-PSMA in mCRPC progressing after docetaxel
Gastrointestinal Cancer
HER2-expressing metastatic colorectal cancer: trastuzumab deruxtecan
REGOMUNE: a phase 2 study combining regorafenib and avelumab
Cardiotoxicity: consider switching to S-1
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