| Abstrakt: |
Background. Both chemotherapy and endocrine therapy can be used as treatments for metastatic breast cancer. We reviewed the evidence to determine whether chemotherapy or endocrine therapy has the most beneficial effect on treatment outcomes (survival, response rate, toxicity and quality of life). Methods. The specialised register maintained by the Editorial Base of the Cochrane Breast Cancer Group was searched. Data were collected from published randomised trials. Hazard ratios were derived for survival analysis and a fixed effect model was used for meta-analysis. Response rates were analysed as dichotomous variables. Toxicity and quality of life data were extracted where present. Results. Ratios of treatment effects are reported so that RRs, HRs and ORs less than 1.0 favour endocrine therapy and values greater than 1.0 favour chemotherapy. The primary analysis of overall survival using hazard ratios derived from published survival curves involved six trials (692 women). There was no significant difference seen (HR = 0.94, 95% CI 0.79–1.12, p= 0.5). A pooled estimate of reported response rates in seven trials involving 767 women shows a significant advantage for chemotherapy over endocrine therapy with RR = 1.25 (1.01–1.54, p= 0.04). However the two largest trials showed trends in opposite directions, and a test for heterogeneity was p= 0.0009, suggesting that this may not be a reliable estimate. There was little information available on toxicity and quality of life. Conclusions. In women with metastatic breast cancer and where hormone receptors are present, a policy of treating first with endocrine therapy rather than chemotherapy is recommended except in the presence of rapidly progressive disease. |
Full text from SpringerLink