Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer
Open accessAbstract
BACKGROUND: Resistance to endocrine therapy in breast cancer is associated with activation of the mammalian target of rapamycin (mTOR) intracellular signaling pathway. In early studies, the mTOR inhibitor everolimus added to endocrine therapy showed antitumor activity. METHODS: In this phase 3, randomized trial, we compared everolimus and exemestane versus exemestane and placebo (randomly assigned in a 2:1 ratio) in 724 patients with hormone-receptor-positive advanced breast cancer who had recurrence or progression while receiving previous therapy with a nonsteroidal aromatase inhibitor in the adjuvant setting or to treat advanced disease (or both). The primary end point was progression-free survival. Secondary end points included survival, response rate, and safety. A preplanned interim analysis was performed by an independent data and safety monitoring committee after 359 progression-free survival events were observed. RESULTS: Baseline characteristics were well balanced between the two study groups. The median age was 62 years, 56% had visceral involvement, and 84% had hormone-sensitive disease. Previous therapy included letrozole or anastrozole (100%), tamoxifen (48%), fulvestrant (16%), and chemotherapy (68%). The most common grade 3 or 4 adverse events were stomatitis (8% in the everolimus-plus-exemestane group vs. 1% in the placebo-plus-exemestane group), anemia (6% vs. <1%), dyspnea (4% vs. 1%), hyperglycemia (4% vs. <1%), fatigue (4% vs. 1%), and pneumonitis (3% vs. 0%). At the interim analysis, median progression-free survival was 6.9 months with everolimus plus exemestane and 2.8 months with placebo plus exemestane, according to assessments by local investigators (hazard ratio for progression or death, 0.43; 95% confidence interval [CI], 0.35 to 0.54; P<0.001). Median progression-free survival was 10.6 months and 4.1 months, respectively, according to central assessment (hazard ratio, 0.36; 95% CI, 0.27 to 0.47; P<0.001). CONCLUSIONS: Everolimus combined with an aromatase inhibitor improved progression-free survival in patients with hormone-receptor-positive advanced breast cancer previously treated with nonsteroidal aromatase inhibitors. (Funded by Novartis; BOLERO-2 ClinicalTrials.gov number, NCT00863655.).
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A number of agents that improve patient outcomes have been approved by regulatory agencies in this setting, including those targeting the mammalian target of rapamycin, phosphatidylinositide 3-kinase, and cyclin-dependent kinase (CDK) pathways.
“In recent years, a number of agents that improve patient outcomes have been approved by regulatory agencies in this setting, including those targeting the mammalian target of rapamycin, phosphatidylinositide 3-kinase, and cyclin-dependent kinase (CDK) pathways.3-5”
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- Authors
- Baselga, J., Campone, M., Piccart, M., Burris, H. A., Rugo, H. S., Sahmoud, T., Noguchi, S., Gnant, M., Pritchard, K. I., Lebrun, F., Beck, J. T., Ito, Y., Yardley, D., Deleu, I., Perez, A., Bachelot, T., Vittori, L., Xu, Z., Mukhopadhyay, P., Lebwohl, D., & Hortobagyi, G. N.
- Affiliations
- Institut de Cancérologie de l'Ouest (FR)
- Institut Jules Bordet (BE)
- Sunnybrook Health Science Centre (CA)
- University of California, San Francisco (US)
- Novartis (United States) (US)
- The University of Osaka (JP)
- Comprehensive Cancer Center Vienna (AT)
- Highlands Oncology Group (US)
- The Cancer Institute Hospital (JP)
- Centre Léon Bérard (FR)
- Novartis (Switzerland) (CH)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-02-09
- Volume
- 366
- Issue
- 6
- Pages
- 520-529
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5705195
- OpenAlex
- W2167188058
- Cited by
- 2,863
- References
- 23
- Citations by year
- 2026: 86 · 2025: 111 · 2024: 132 · 2023: 156 · 2022: 144 · 2021: 176 · 2020: 185 · 2019: 175 · 2018: 208 · 2017: 253 · 2016: 244 · 2015: 268 · 2014: 275 · 2013: 303 · 2012: 139
- FWCI
- 196.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › PI3K/AKT/mTOR signaling in cancer
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- everolimus, hormone receptor-positive breast cancer, advanced breast cancer, postmenopausal women, exemestane, aromatase inhibitors, mTOR inhibition, endocrine therapy resistance, progression-free survival, stomatitis, adverse events, combination therapy, fulvestrant, letrozole, anastrozole, tamoxifen, fulvestrant resistance
- MeSH terms
- Everolimus, Adult, Aged, Aged, 80 and over, Androstadienes, Antineoplastic Combined Chemotherapy Protocols, Bone Neoplasms, Breast Neoplasms, Female, Humans, Middle Aged, Recurrence, Stomatitis, Postmenopause, Disease-Free Survival, Sirolimus, Aromatase Inhibitors, Kaplan-Meier Estimate, TOR Serine-Threonine Kinases, ErbB Receptors
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