Devita, Hellman, and Rosenberg's Cancer

LWBK1006-24 LWW-Govindan-Review December 12, 2011 19:15

346 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 24.35. The answer is B.

The addition of bevacizumab to paclitaxel significantly prolonged

progression-free survival (11.8 vs. 5.9 months; hazard ratio [HR]=

0.60,p<.001) and increased objective response rate (36.9% vs. 21.2%;

p<.001), but median OS was similar in both groups (26.7 vs. 25.2

months; HR=0.88,p=.16). Grade 3/4 hypertension (15% vs. 0%;

p=.001) and cerebrovascular ischemia (2% vs. 0%;p=.009) were

both more frequent in patients receiving paclitaxel+bevacizumab. (See

text: Antiangiogenesis Therapy for Advanced Breast Cancer. See also

Miller K, Wang M, Gralow J, et al. Paclitaxel plus bevacizumab versus

paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357:

2666–2676.)

Answer 24.36. The answer is D.

The addition of lapatinib to capecitabine in patients with advanced

HER2+breast cancer increased TTP (HR 0.49;p<.001). The most

common toxicities were diarrhea, hand-foot syndrome, nausea, fatigue,

vomiting, and rash. Diarrhea and rash were significantly more frequent

in patients receiving combined therapy. Although OS data are not yet

mature, to date there is no improvement in OS. (See text: Anti-HER2 Ther-

apy for Metastatic Breast Cancer. See also Geyer CE, Forster J, Lindquist

D, et al. Lapatinib plus capecitabine for HER2-positive advanced breast

cancer. N Engl J Med. 2006;355:2733.)

Answer 24.37. The answer is C.

The EFECT trial compared fulvestrant and exemestane in post-

menopausal women progressing on a nonsteroidal AI. Response rate,

clinical benefit, and TTP were identical, suggesting either fulvestrant

or exemestane would be reasonable options. However, the EFECT trial

used a loading dose of fulvestrant (500 mg on day 0, 250 mg on days

14 and 28, and then monthly) to achieve steady-state potentially ther-

apeutic levels within the first month. (See text: Endocrine Therapy for

Metastatic Breast Cancer. See also Gradishar W, Chia S, Piccart-Gebhart

M, et al. Fulvestrant versus exemestane following prior non-steroidal AI

therapy: First results from EFECT, a randomized phase II trial in post-

menopausal women with advanced breast cancer. Breast Cancer Res and

Treat. 2006;100:S8–S9.)

Answer 24.38. The answer is A.

Ixabepilone increased objective response rate by both the investigator

(23% vs. 42%) and independent radiologic review (14% vs. 35%).

Ixabepilone causes significantly more neutropenia (11% vs. 68%)

than capecitabine alone. Neutropenic fevers were uncommon but were

increased with ixabepilone (<1% vs. 4%,p<.001). (See Thomas ES,

Gomez HL, Li RK, et al. Ixabepilone plus capecitabine for metastatic

breast cancer progressing after anthracycline and taxane treatment. J Clin

Oncol. 2007;25:5210–5217.)