Preserving Quality of Life for Patients During Palliative Treatment of Triple-Negative Breast Cancer

Prognosis and Treatment of Triple-Negative Breast Cancer

Approximately 15% of all breast tumors are classified as triple-negative (without expression of estrogen and progesterone receptors and with normal HER2 expression). The goal of therapy for these tumors is to delay disease progression while maintaining the quality of life for patients, and chemotherapy has long been the only available standard treatment. Many combined chemotherapeutic regimens may result in better efficiency compared to monotherapy, but these results are often paid for with increased toxicity and deterioration in patients' quality of life.

For patients with positive expression of the programmed death-ligand 1 receptor (PD-L1), it is now possible to administer a combined treatment of nab-paclitaxel and atezolizumab (a monoclonal antibody specifically blocking PD-L1) as a first-line treatment. The IMpassion130 study showed improvement in progression-free survival (PFS) in PD-L1-positive patients (PFS 7.5 months on combined treatment compared to 5.0 months on nab-paclitaxel monotherapy). The authors of the study have now published an analysis of the quality of life of patients based on predefined outcomes tracked by the patients themselves.

Study Methodology and Aims of the Analysis

The study included patients with previously untreated locally advanced or metastatic triple-negative breast cancer, who were randomized to receive either 840 mg atezolizumab or placebo every 2 weeks in combination with 100 mg/m² nab-paclitaxel on days 1, 8, and 15 of each 28-day cycle, until disease progression or therapy intolerance.

Patients completed the QLQ-C30 quality of life questionnaire prepared by the European Organization for Research and Treatment of Cancer (EORTC), as well as its specific module for breast cancers (QLQ-BR23) on the first day of each treatment cycle, at the end of therapy, and every 4 weeks for a year. The outcome of the analysis was the time to deterioration (TTD) of health-related quality of life (HRQoL), defined as the first drop of ≥ 10 points compared to baseline, lasting for at least 2 cycles. TTD in daily functioning and the occurrence of symptoms related to the disease or its treatment were also tracked.

Results

92% of patients completed the QLQ-C30 questionnaire at the study entry, 89% also completed the QLQ-BR23 questionnaire, and more than 80% provided responses up to the 20th treatment cycle. At the start of the study, comparable baseline values for average HRQoL scores, levels of physical functions, and managing corresponding life roles were recorded in both groups. No clinically significant changes from baseline were observed during treatment.

No significant differences were observed between study arms in the PD-L1-positive population for the average time to HRQoL decline (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.69−1.28). Differences were also not recorded for TTD in physical functions (HR 1.02; 95% CI 0.76−1.37) or life roles (HR 0.77; 95% CI 0.57−1.04). No clinically significant worsening of treatment-related symptoms (fatigue, diarrhea, or nausea and vomiting) was observed between the study arms.

Conclusion

The addition of atezolizumab to nab-paclitaxel therapy in patients with metastatic triple-negative breast cancer delayed disease progression without negatively impacting daily functioning or patients' quality of life.

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Source: Adams S., Diéras V., Barrios C. H. et al. Patient-reported outcomes from the phase III IMpassion130 trial of atezolizumab plus nab-paclitaxel in metastatic triple-negative breast cancer. Ann Oncol 2020; 31 (5): 582–589, doi: 10.1016/j.annonc.2020.02.003.