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Evidence summaries

Chemotherapy Alone Versus Endocrine Therapy Alone for Metastatic Breast Cancer

Endocrine therapy appears to be as effective as chemotherapy in terms of survival for metastatic breast cancer. Level of evidence: "B"

A Cochrane review (abstract , review [Abstract]) included 8 studies with a total of 817 patients. The primary analysis of overall effect 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 to 1.12, p=0.5). A test for heterogeneity was p=0.1. A pooled estimate of reported response rates in eight trials involving 817 women shows a significant advantage for chemotherapy over endocrine therapy with RR=1.25 (95% CI 1.01 to 1.54, p=0.04). However the two largest trials showed trends in opposite directions, and a test for heterogeneity was p=0.0018. Six of the seven fully published trials commented on increased toxicity with chemotherapy, mentioning nausea, vomiting and alopecia.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).

    References

    • Wilcken N, Hornbuckle J, Ghersi D. Chemotherapy alone versus endocrine therapy alone for metastatic breast cancer. Cochrane Database Syst Rev 2003;(2):CD002747 [Review content assessed as up-to-date: 23 September 2010]. [PubMed]

Primary/Secondary Keywords