Chemotherapy Alone Versus Endocrine Therapy Alone for Metastatic Breast Cancer

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]