Evaluation of tumor response, disease control, progression-free survival, and time to progression as potential surrogate end points in metastatic breast cancer.

PURPOSE: Overall survival (OS) can be observed only after prolonged follow-up, and any potential effect of first-line therapies on OS may be confounded by the effects of subsequent therapy. We investigated whether tumor response, disease control, progression-free survival (PFS), or time to progression (TTP) could be considered a valid surrogate for OS to assess the benefits of first-line therapies for patients with metastatic breast cancer. PATIENTS AND METHODS: Individual patient data were collected on 3,953 patients in 11 randomized trials that compared an anthracycline (alone or in combination) with a taxane (alone or in combination with an anthracycline). Surrogacy was assessed through the correlation between the end points as well as through the correlation between the treatment effects on the end points. RESULTS: Tumor response (survival odds ratio [OR], 6.2; 95% CI, 5.3 to 7.0) and disease control (survival OR, 5.5; 95% CI, 4.8 to 6.3) were strongly associated with OS. PFS (rank correlation coefficient, 0.688; 95% CI, 0.686 to 0.690) and TTP (rank correlation coefficient, 0.682; 95% CI, 0.680 to 0.684) were moderately associated with OS. Response log ORs were strongly correlated with PFS log hazard ratios (linear coefficient [rho], 0.96; 95% CI, 0.73 to 1.19). Response and disease control log ORs and PFS and TTP log hazard ratios were poorly correlated with log hazard ratios for OS, but the confidence limits of rho were too wide to be informative. CONCLUSION: No end point could be demonstrated as a good surrogate for OS in these trials. Tumor response may be an acceptable surrogate for PFS.

Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer.

PURPOSE: Taxanes (paclitaxel or docetaxel) have been sequenced or combined with anthracyclines (doxorubicin or epirubicin) for the first-line treatment of advanced breast cancer. This meta-analysis uses data from all relevant trials to detect any advantages of taxanes in terms of tumor response, progression-free survival (PFS), and survival. PATIENTS AND METHODS: Individual patient data were collected on eight randomized combination trials comparing anthracyclines + taxanes (+ cyclophosphamide in one trial) with anthracyclines + cyclophosphamide (+ fluorouracil in four trials), and on three single-agent trials comparing taxanes with anthracyclines. Combination trials included 3,034 patients; single-agent trials included 919 patients. RESULTS: Median follow-up of living patients was 43 months, median survival was 19.3 months, and median PFS was 7.1 months. In single-agent trials, response rates were similar in the taxanes (38%) and in the anthracyclines (33%) arms (P = .08). The hazard ratios for taxanes compared with anthracyclines were 1.19 (95% CI, 1.04 to 1.36; P = .011) for PFS and 1.01 (95% CI, 0.88 to 1.16; P = .90) for survival. In combination trials, response rates were 57% (10% complete) in taxane-based combinations and 46% (6% complete) in control arms (P < .001). The hazard ratios for taxane-based combinations compared with control arms were 0.92 (95% CI, 0.85 to 0.99; P = .031) for PFS and 0.95 (95% CI, 0.88 to 1.03; P = .24) for survival. CONCLUSION: Taxanes were significantly worse than single-agent anthracyclines in terms of PFS, but not in terms of response rates or survival. Taxane-based combinations were significantly better than anthracycline-based combinations in terms of response rates and PFS, but not in terms of survival.

Chemically tagging the Hyades stream: does it partly originate from the Hyades cluster?

The Hyades stream has long been thought to be a dispersed vestige of the Hyades cluster. However, recent analyses of the parallax distribution, of the mass function, and of the action-space distribution of stream stars have shown it to be rather composed of orbits trapped at a resonance of a density disturbance. This resonant scenario should leave a clearly different signature in the element abundances of stream stars than the dispersed cluster scenario, since the Hyades cluster is chemically homogeneous. Here, we study the metallicity as well as the element abundances of Li, Na, Mg, Fe, Zr, Ba, La, Ce, Nd and Eu for a random sample of stars belonging to the Hyades stream, and compare them with those of stars from the Hyades cluster. From this analysis: (i) we independently confirm that the Hyades stream cannot be solely composed of stars originating in the Hyades cluster; (ii) we show thatsomestars (namely 2/21) from the Hyades stream nevertheless have abundances compatible with an origin in the cluster; (iii) we emphasize that the use of Li as a chemical tag of the cluster origin of main-sequence stars is very efficient in the range 5500K ≤Teff≤ 6200K, since the Li sequence in the Hyades cluster is very tight, while at the same time spanning a large abundance range; (iv) we show that, while this evaporated population has a metallicity excess of ~0.2 dex with respect to the local thin-disc population, identical to that of the Hyades cluster, the remainder of the Hyades stream population has still a metallicity excess of ~0.06-0.15 dex, consistent with an origin in the inner Galaxy and (v) we show that the Hyades stream can be interpreted as an inner 4:1 resonance of the spiral pattern: this then also reproduces an orbital family compatible with the Sirius stream, and places the origin of the Hyades stream up to 1kpc inwards from the solar radius, which might explain the observed metallicity excess of the stream population. © 2011 The Authors Monthly Notices of the Royal Astronomical Society © 2011 RAS.