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Breast Cancer Res Treat. 2020 Feb 1. doi: 10.1007/s10549-020-05551-3. [Epub ahead of print]

Anastrozole plus fulvestrant vs. anastrozole alone for hormone receptor-positive advanced breast cancer: a meta-analysis of randomized controlled trials.

Li M1,2, Xiong Y1,2, Liao C2,3, He Y2,3, Duan S3, Yi F4, Wei Y1, Zhang W5.

Author information

1
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China.
2
Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
3
Department of Breast Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
4
Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
5
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China. zwx123dr@126.com.

Abstract

BACKGROUND:

For patients with hormone receptor (HR)-positive advanced breast cancer, whether the combination of anastrozole and fulvestrant is more effective than anastrozole alone is controversial. Our meta-analysis aimed to compare the efficacy and safety of the two therapies.

METHODS:

We retrieved relevant studies in Embase, the Cochrane Library, Ovid MEDLINE, PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar. The primary outcomes were overall survival (OS) and progression-free survival (PFS). The secondary outcomes were the disease control rate (DCR), the objective response rate (ORR), and adverse events (AEs).

RESULTS:

Five articles based on 4 randomized controlled trials containing 2146 patients were identified in our meta-analysis. The combination group had better efficacy in the endpoints of OS (hazard ratio [HR] 0.86; 95% confidence interval [CI] 0.74-0.99, p = 0.03) and PFS (HR 0.87; 95% CI 0.77-0.97, p = 0.02). Regarding the ORR, DCR, total AEs and grade 3-5 AEs, we found no difference between the two treatments. The combination group showed a clearly higher rate of treatment discontinuations (95% CI 1.05-3.60, p = 0.03) and AEs leading to death (95% CI 1.12-9.11, p = 0.03). The subgroup analysis of AEs showed an increased incidence of extremity or muscle pain, hematologic effects, gastrointestinal disorders, and hot flashes in the combination group.

CONCLUSIONS:

For HR-positive advanced breast cancer patients, the combination of anastrozole and fulvestrant appears to be superior to anastrozole alone in extending PFS and OS, despite relatively serious AEs.

KEYWORDS:

Anastrozole; Breast cancer; Fulvestrant; Hormone receptor positive; Meta-analysis

PMID:
32008124
DOI:
10.1007/s10549-020-05551-3

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