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San Antonio Breast Cancer Symposium, December 9-13, 2014
Patient-reported endocrine
symptoms, sexual functioning and
quality of life (QoL) in the IBCSG
SOFT trial
Karin Ribi
for SOFT Investigators,
International Breast Cancer Study Group,
Breast International Group,
and North American Breast Cancer Group
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Co-Authors:
Weixiu Luo
Jürg Bernhard
Prudence A. Francis
Meritxell Bellet
Harold J. Burstein
Lorenzo Pavesi
Vani Parmar
Carlo Tondini
Marilena Visini
Roberto Torres
Per Karlsson
Simon Spazzapan
Antoni Avella
Thomas Ruhstaller
Fabio Puglisi
Meredith M. Regan
Alan S. Coates
Richard D. Gelber
Gini F. Fleming
SOFT
• Trial coordinated by
• Collaboration of
• Financial support/drug supply: Pfizer, Ipsen, US NCI
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Background
• SOFT efficacy results show that Tamoxifen
(T)+Ovarian Function Suppression (OFS) provides
improved disease control compared with T for the
cohort of patients who received prior chemotherapy
• In premenopausal women with breast cancer
receiving adjuvant endocrine therapy with OFS little
is known about
– Patient-reported endocrine symptoms
– Sexual function
– Quality of life
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Background
• In the ZIPP trial1 more endocrine symptoms and
worse sexual function were reported for T+Goserelin
and Goserelin, but not for T, when compared to no
treatment in patients without chemotherapy.
• The TEXT /SOFT trials2 comparing Exemestane
(E)+OFS vs. T+OFS found no effects on overall QoL,
but differential effects on endocrine symptoms.
• In E-3193 node negative trial3 no chemo was allowed.
Patients reported more menopausal symptoms, lower
sexual activity and worse QoL at 3 y with Tam+OFS vs
Tam, with subsequent lessening of differences.
1
Nystedt et al; JCO 2003; Berglund et al., JCO 2001
2 Bernhard et al; JCO 2014, (suppl; abstr 557)
3Tevaarwerk et al; JCO 2014
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San Antonio Breast Cancer Symposium, December 9-13, 2014
SOFT QoL Assessment
3047 Patients Randomized in ITT, Dec 2003 - Jan 2011
Two Patient Cohorts
No Chemotherapy (47%)
Premenopausal, within 12 weeks of surgery
(Median time since surgery = 1.8 months)
Prior Chemotherapy (53%)
Premenopausal* after completing chemotherapy;
Randomization within 8 months of completion
(Median time since surgery = 8.0 months)
R
A
N
D
O
M
I
Z
E
Primary Analysis (n=2033)
Tamoxifen x 5y
(n=1018)
Tamoxifen+OFS x 5y
(n=1015)
Exemestane+OFS x 5y (n=1014)
Median follow-up 67 months
OFS=ovarian function suppression
Treatment month
0 6 12 18 24
36
48
QoL assessment time points
*According to locally-determined E2 level in premenopausal range
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60
San Antonio Breast Cancer Symposium, December 9-13, 2014
SOFT QoL Eligibility
• SOFT eligibility criteria
• Completed baseline forms
– prior to randomization (IBCSG centers), OR
– prior to initiation of protocol therapy (all other
centers)
• Exclusion:
– cognitive or physical impairment interfering with
form completion
– inability to read any of the 26 languages available
on the QoL forms
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San Antonio Breast Cancer Symposium, December 9-13, 2014
SOFT QoL Measures
• Symptom indicators
• Global QoL indicators
– Physical well-being
– Mood
– Coping effort
– Treatment burden
• All indicators in linear analogue self-assessment
(LASA/VAS) format (score range: 0 to 100)
• Higher numbers reflecting better condition
• Clinically significant change: at least +/- 8 points
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San Antonio Breast Cancer Symposium, December 9-13, 2014
SOFT QoL Hypotheses
• Patients receiving T+OFS compared to those with T
alone will report
–
–
–
–
–
–
more hot flushes
greater loss of sexual interest
more vaginal dryness
being more troubled by weight gain
more sleep problems
less vaginal discharge
• Patients receiving T+OFS will report no differences in
global QoL indicators, but higher treatment burden
compared to those with T alone
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San Antonio Breast Cancer Symposium, December 9-13, 2014
SOFT QoL Analysis
• ITT analysis
• Differences in QoL changes between treatments
tested overall and by chemotherapy cohort at:
• short–term (6 months)
• mid–term (24 months)
• long–term (60 months) post-randomization
• Mixed-effects linear modeling for repeated measures
including chemo cohort, treatment, time point, and
interactions
• Adjusted for baseline patient/disease characteristics
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Patient Population
SOFT
Randomized in ITT (N=3047)
N=2033
Tam (N=1018)
T+OFS (N=1015)
E+OFS (N=1014)
QoL Analysis Exclusions (N=157):
QoL Analysis Exclusions (N=154):
QoL Analysis Exclusions (N=160):
•QoL Exemption (N=8)
•Centers poor compliance (N=148)
•QoL data completely missing (N=1)
•QoL Exemption (N=8)
•Centers poor compliance (N=145)
•QoL data completely missing (N=1)
•QoL Exemption (N=9)
•Centers poor compliance (N=149)
•QoL data completely missing (N=2)
QoL Analysis T+OFS (N=861)
QoL Analysis E+OFS (N=854)
QoL Analysis T (N=861)
ITT OFS QoL Analysis
N=1722
Overall QoL participation rate: 84%
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Patient Characteristics
No Chemo
(N=772)
Prior Chemo
(N=950)
Overall
(N=1722)
Age (median)
46
40
43
BMI (median)
24
26
25
Surgery to random. (median)
1.8 mo
8.1 mo
3.6 mo
Taking tamoxifen at baseline
6%
45%
27%
Node positive
9%
57%
35%
Tumor size > 2 cm
14%
46%
32%
HER2 positive
5%
19%
13%
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Baseline QoL Scores
Type of indicator
Vasomotor
Gynecological/
Sexual problems
Musculoskeletal/
Neurology pain
QoL indicator*
No Chemo
Prior Chemo
Mean
S.D.
Mean
S.D.
Hot flushes
90
19
71
32
Sweats
86
20
74
29
Vaginal discharge
88
18
79
23
Vaginal dryness
91
17
80
26
Vaginal itching/irritation
92
16
86
22
Loss of sexual interest
79
27
67
31
Difficulties becoming
aroused
84
22
72
28
Bone or Joint pains
83
23
75
28
Headaches
82
23
83
22
*Higher scores indicate a better condition
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Baseline QoL Scores (cont.)
Type of indicator
Constitutional/
Psychological
Global indicators
QoL indicator*
No Chemo
Prior Chemo
Mean
S.D.
Mean
S.D.
Sleep disturbance
71
27
67
29
Troubled by weight gain
84
24
69
31
Being irritable
75
24
72
25
Feeling dizzy
90
17
87
20
Physical well-being
76
22
77
22
Mood
Coping effort
72
68
23
22
26
75
68
Treatment burden
78
24
71
25
26
*Higher scores indicate a better condition
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Hot Flushes
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San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Symptoms
T+OFS vs. T
T+OFS
T
Hot flushes
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Symptoms
T+OFS vs. T
T+OFS
T
Hot flushes
Sweats
Vaginal discharge
Vaginal dryness
Vaginal itching/irritation
Loss of sexual interest
Arousal difficulties
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Symptoms
E+OFS
T+OFS
T
E+OFS
Hot flushes
Sweats
Vaginal discharge
Vaginal dryness
Vaginal itching/irritation
Loss of sexual interest
Arousal difficulties
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Symptoms (cont.)
T+OFS vs. T
T+OFS
T
Bone or joint pain
Headaches
Sleep disturbance
Weight gain
Being irritable
Feeling dizzy
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Symptoms (cont.)
E+OFS
T+OFS
T
E+OFS
Bone or joint pain
Headaches
Sleep disturbance
Weight gain
Being irritable
Feeling dizzy
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Global QoL
T+OFS vs. T
T+OFS
T
Physical wellbeing
Mood
Coping effort
Treatment burden
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: Global QoL
E+OFS
T+OFS
T
E+OFS
Physical wellbeing
Mood
Coping effort
Treatment burden
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: by Cohort
Changes from baseline to month 6 for selected indicators
T+OFS
T
Hot flushes
(mean diff = – 26)
(mean diff = –32)
Sweats
Loss of sexual interest
Bone or joint pain
Sleep disturbance
(mean diff = – 15)
(mean diff = – 6)
Coping effort
Treatment burden
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Treatment Effect: by Cohort
Changes from baseline to month 6 for selected indicators
T+OFS
T
E+OFS
Hot flushes
Sweats
Loss of sexual interest
Bone or joint pain
Sleep disturbance
Coping effort
Treatment burden
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Conclusions
• Overall, patients receiving T+OFS experienced worse
endocrine symptoms and sexual functioning than
those receiving T alone.
• Most differences in symptoms between treatments
were seen during the first 2 years of treatment, no
longer apparent at 5 years.
• Global QoL did not differ between T+OFS and T alone.
• E+OFS vs. T+OFS showed differential effects on
endocrine symptoms burden, but not on global QoL
indicators.
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
Conclusions
• Less improvement in coping and greater treatment
burden were seen with T+OFS vs. T in patients with no
prior chemotherapy.
• For patients who received prior chemotherapy,
differences in endocrine symptoms between T+OFS
and T were less pronounced.
• The cohort of women receiving prior chemotherapy
benefited most from OFS in terms of disease control.
This presentation is the intellectual property of the author/presenter. Contact [email protected] for permission to reprint and/or distribute.
San Antonio Breast Cancer Symposium, December 9-13, 2014
IBCSG Thanks
IBCSG
• Patients for completing multiple
QoL forms
• Physicians, nurses, data and trial
coordinators, in 358 centers
worldwide
• IBCSG Data Management
Center, Coordinating Center,
Statistical Center
• STP Steering Committee
IBCSG
ANZBCTG
SAKK
GOCCHI
CEEOG
EORTC
GBG
ICORG
NCRI/ICR-CTSU
SOLTI
US NCI
Alliance
(CALGB,
ACOSOG,
NCCTG)
SWOG
ECOG-ACRIN
NRG (NSABP,
RTOG)
NCIC-CTG
NCI CTSU
This presentation is the intellectual property of the author/presenter. Contact insert your email address here for permission to reprint and/or distribute.