Clinical Evidence of Chemotherapy or Endocrine Therapy Maintenance in Patients with Metastatic Breast Cancer: Meta-Analysis of Randomized Clinical Trials and Propensity Score Matching of Multicenter Cohort Study

Wei Ren, Yunfang Yu, Huangming Hong, Ying Wang, Quanlong Gao, Yongjian Chen, Peixian Chen, Jianli Zhao, Qiyun Ou, Dagui Lin, Tuping Fu, Yujie Tan, Chenchen Li, Xinxin Xie, Guolin Ye, Jun Tang, Herui Yao, Wei Ren, Yunfang Yu, Huangming Hong, Ying Wang, Quanlong Gao, Yongjian Chen, Peixian Chen, Jianli Zhao, Qiyun Ou, Dagui Lin, Tuping Fu, Yujie Tan, Chenchen Li, Xinxin Xie, Guolin Ye, Jun Tang, Herui Yao

Abstract

Purpose: This study aims to comprehensively evaluate the clinical efficacy of chemotherapy or endocrine therapy maintenance in metastatic breast cancer (MBC) patients.

Materials and methods: The meta-analysis of randomized clinical trials (RCTs) and propensity score matching of multicenter cohort study evaluated MBC patients who underwent first-line chemotherapy or endocrine therapy maintenance. This study is registered with PROSPERO: CRD42017071858 and ClinicalTrials.gov: NCT04258163.

Results: A total of 2,867 patients from 15 RCTs and 760 patients from multicenter cohort were included. The results from meta-analysis showed that chemotherapy maintenance improved progression-free survival (PFS) (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.54 to 0.73; p < 0.001; moderate-quality evidence) and overall survival (OS) (HR, 0.87; 95% CI 0.78 to 0.97; p=0.016; high-quality evidence) than observation. In the cohort study, for hormone receptor-positive MBC patients, chemotherapy maintenance improved PFS (HR, 0.67; 95% CI, 0.52 to 0.85; p < 0.001) and OS (HR, 0.55; 95% CI 0.42 to 0.73; p < 0.001) compared with observation, and endocrine therapy maintenance also improved PFS (HR, 0.65; 95% CI, 0.53 to 0.80; p < 0.001) and OS (HR, 0.55; 95% CI, 0.44 to 0.69; p < 0.001). There were no differences between chemotherapy and endocrine therapy maintenance in PFS and OS (all p > 0.05). Regardless of the continuum or switch maintenance therapy, showed prolonged survival in MBC patients who were response to first-line treatment.

Conclusion: This study provided evidences for survival benefits of chemotherapy and endocrine therapy maintenance in MBC patients, and there was no difference efficacy between chemotherapy and endocrine therapy maintenance for hormone receptor-positive patients.

Keywords: Chemotherapy; Endocrine therapy; Metastatic breast neoplasms; Overall survival; Progression-free survival.

Conflict of interest statement

Conflicts of Interest

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1
Fig. 1
Study design and patient recruitment. HR, hormone receptor.
Fig. 2
Fig. 2
Pooled HRs for progression-free survival (A) and overall survival (B) with chemotherapy maintenance versus observation [–,–20,22]. CI, confidence interval; FESG, French Epirubicin Study Group; HR, hazard ratio.
Fig. 3
Fig. 3
Progression-free survival and overall survival among patients with chemotherapy maintenance versus observation before and after matching in multicenter cohort: progression-free survival before matching (A), overall survival before matching (B), progression-free survival after matching (C), and overall survival after matching (D). CI, confidence interval; HR, hazard ratio.
Fig. 4
Fig. 4
Progression-free survival and overall survival among patients with endocrine therapy maintenance versus observation before and after matching in multicenter cohort: progression-free survival before matching (A), overall survival before matching (B), progression-free survival after matching (C), and overall survival after matching (D). CI, confidence interval; HR, hazard ratio.
Fig. 5
Fig. 5
Progression-free survival and overall survival among patients with chemotherapy versus endocrine therapy maintenance before and after matching in multicenter cohort: progression-free survival before matching (A), overall survival before matching (B), progression-free survival after matching (C), and overall survival after matching (D). CI, confidence interval; HR, hazard ratio.

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