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J Cell Physiol. 2017 Jun;232(6):1571-1578. doi: 10.1002/jcp.25685. Epub 2016 Nov 30.

A Real-World Multicentre Retrospective Study of Paclitaxel-Bevacizumab and Maintenance Therapy as First-Line for HER2-Negative Metastatic Breast Cancer.

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Medical Oncology Unit, Frosinone, Italy.
Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell' Invecchiamento e Medicina Traslazionale - CeSI-MeT, Chieti, Italy.
Bio-Statistics Unit, Regina Elena National Cancer Institute, Rome, Italy.
Department of Medical Oncology, Policlinico Universitario A. Gemelli, Rome, Italy.
Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
Division of Medical Oncology 1, Regina Elena National Cancer Institute, Rome, Italy.
Medical Oncology Unit, Nuoro, Italy.
Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy.
Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
Medical Oncology Unit, Regina Apostolorum Hospital, Albano, Rome, Italy.
Medical Oncology Unit, Ospedale San Pietro Fatebenefratelli, Rome, Italy.
Medical Oncology Unit, Policlinico Umberto I, Rome, Italy.
Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy.
Department of Medical and Surgical Sciences for Children and Adults, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.


Bevacizumab in combination with taxanes in HER2-negative metastatic breast cancer (MBC) patients has shown improved progression-free survival (PFS), despite the lack of clear overall survival (OS) benefit. We performed a retrospective analysis to evaluate the impact of paclitaxel-bevacizumab and of maintenance therapy with bevacizumab (BM) and endocrine therapy (ET) in the real-world practice. We identified 314 HER2-negative MBC patients treated in 12 cancer centers. Overall, the median PFS and OS were 14 and 40 months, respectively. Among the 254 patients potentially eligible for BM, 183 received BM after paclitaxel discontinuation until progression/toxicity. PFS and OS were improved in patients who had received BM in comparison with those potentially eligible but who did not receive BM (P< 0.0001 and P = 0.001, respectively). Results were confirmed when adjusting for propensity score. Among the 216 hormone-receptor positive patients eligible for BM, a more favorable PFS and OS were observed when maintenance ET was administered (P < 0.0001). Multivariate analysis showed that PS, BM, number of disease sites and maintenance ET were related to PFS, while response and maintenance ET were related to OS. In hormone-receptor positive patients, BM produced a significant PFS and a trend towards OS benefit only in absence of maintenance ET (P = 0.0007 and P = 0.06, respectively). In the triple-negative subgroup, we observed a trend towards a better OS for patients who received BM (P = 0.06), without differences in PFS (P = 0.21). Our results confirmed the efficacy of first-line paclitaxel-bevacizumab in real-world practice; both BM and maintenance ET significantly improved PFS and OS compared to no maintenance therapies. J. Cell. Physiol. 232: 1571-1578, 2017.

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