Quality of life in postmenopausal patients with breast cancer after failure of tamoxifen: Formestane versus megestrol acetate as second-line hormonal treatment

The Swiss Group for Clinical Cancer Research (SAKK) compared efficacy and toxicity of formestane (250 mg intramuscularly (i.m.) every 2 weeks) versus megestrol acetate (MGA; 160 mg orally daily) as second-line treatment in postmenopausal patients with advanced breast cancer and disease progression while on tamoxifen treatment in a randomised trial (Thurlimann B, Castiglione M, Hsu Schmitz SF, et aL Eur J Cancer 1997, 33, 1017-1024). Quality of life (QL) was evaluated as a secondary endpoint (n = 177). Overall, 83% (6691805) of expected QL forms were received, 88% (1551177) at baseline, 88% (4021457) on study treatment, and 65% (1121171) at treatment failure. Patients with no impairment in performance status reported better physical well-being (P=0.0001), mood (P=0.0007) and coping (P=0.03), and less tiredness (P=0.0001) and appetite/sense of taste disturbance (P=0.0001) at baseline. After adjustment for baseline, there was no statistically significant difference in QL by treatment. Baseline QL was strongly predictive for QL under treatment but not for time to treatment failure. In conclusion, the question of whether oestrogen deprivation (e.g. formestane) or addition of progesterone (MGA) has a more beneficial impact on QL needs further investigation. The subjective experience of second-line endocrine treatment varies considerably as a consequence of the large variation in the individual course of the disease and has to be judged on an individual basis.