Ibrance and Letrozole: Newly Diagnosed Treatment

I included the link so that people can read the whole article and am glad that you did. In a few places the author noted where the results of both drugs v. letrozole and a placebo or letrozole alone "were not statistically significant." I assume that it is that, that points to a lack of clear benefit that led to the headline conclusion.

The authors cited the problem of missing data as you noted. But statistically-valid conclusions cannot be drawn by ignoring missing data in such a study. That would be cherry-picking data or biased outcome.

So they mentioned what they could deduce (which you excerpted) from the incomplete data but nonerheless concluded as stated in the headline. At least that's what I deduce from the seeming discrepancies.

It would be valuable to know the cause of the missing data. E.g., if people dropped out if the study and why. And why it was the missing data was "disproportionate"? One reason people drop our of studies is adverse effects. In such a case, had the people stayed in the study, several of the measure variables would have been negatively affected.

But here's one conclusion from the study and the link again for anyone interested.
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“Overall survival was numerically longer in the palbociclib-plus-letrozole arm, but the results were not statistically significant,” Dr. Finn announced. “The interpretation of overall survival is limited by the large and disproportionate percentage of patients with missing survival data [ie, lost to follow-up or censored] between the treatment arms.”
https://ascopost.com/news/july-2022/no-overall-survival-benefit-reported-with-palbociclibletrozole-in-advanced-breast-cancer/

@callalloo the conclusions of this study were more complicated, mainly because of missing date that affected results. All in all the article you linked favors the use of both drugs, Femara and Ibrance (brand names). I urge people to read the entire article and not just the headline, which is misleading. I am posting excerpts and hope people will read them.

"To demonstrate the impact of missing data, Dr. Finn showed a post hoc analysis excluding patients for whom survival data were not available. In that analysis, the median overall survival was 51.6 months with palbociclib/letrozole vs 44.6 months with letrozole alone (HR = 0.869; 95% CI = 0.706–1.069)."

"The time to chemotherapy was 38.1 months with palbociclib/letrozole vs 29.8 months with letrozole alone (HR = 0.730; 95% CI = 0.607–0.879)."

"Regarding other outcomes that affected quality of life, Dr. Finn reported the median duration of treatment and the time to chemotherapy were prolonged with palbociclib plus letrozole. The median treatment duration was 22.0 months vs 13.8 months, and at each benchmark, more of the palbociclib arm were still on treatment. “At 6 years or longer, this was three times as many (16% vs 5%),” he noted."

" For the largest subgroup of patients—those with a disease-free interval of more than 12 months—overall survival increased from 44.6 months in the control arm to 64.0 months with palbociclib/letrozole"

Please note that the study did note the effectiveness of letrozole. It just didn't find better results by adding palbociclib.

What were your side effects from both drugs?

The following was in today's ASCO Post.
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PALOMA-2: No Overall Survival Benefit Reported With Palbociclib/Letrozole in Advanced Breast Cancer

"The final overall survival analysis of the phase III PALOMA-2 trial has shown no significant benefit for palbociclib given with letrozole, vs letrozole and placebo, as a first-line treatment in hormone receptor–positive, HER2-negative metastatic breast cancer."

The results were reported at the 2022 ASCO Annual Meeting by Richard Finn, MD, Professor of Medicine at the David Geffen School of Medicine, University of California, Los Angeles."
https://ascopost.com/news/july-2022/no-overall-survival-benefit-reported-with-palbociclibletrozole-in-advanced-breast-cancer/

I don't know the other gene tests so will let someone else give it a try ;-). There is one thread that has Oncotype in the title but seemingly little activity. And others ask new posters on non-Oncotype threads if they've had the test. Et, voila, the Oncotype stuff becomes part of that thread then. But I get your point.

This thread is about Ibrance and Letrozole, which are prescribed for metastatic breast cancer. @shortie0650 do you have stage 4?

There are other threads about the decision to take anti-estrogen drugs, where most posts are stage 1. (I always wish people would try the meds. Forums tend to scare people away from them entirely.)

I understand that there are many tests. My point was that the conversation about these tests seems to be repeated in many threads where it really isn’t relevant to the topic of the thread. Maybe you could start a new thread about the available genetic tests, and keep that conversation going there. There are other folks who are taking part in those conversations so it should be relatively lively, as well as making space in other threads for on topic conversation.

Chris, there are a lot of posts about the gene testing, the OncotypeDX being the most frequent one for estrogen-positive breast cancer. And there are misconceptions about it that are still out there, including among doctors according to an article I cited, with URL, on a thread. If a moderator can move those to a separate thread, the information would be in one place for anyone wanting to understand why the test is used and how to interpret the results when it is.

I work with statistics and have not seen the word 'absolute' used with respect to any cancer risk or expected outcomes in general. Or used for macro statistics at all.. So I think, but am not certain, that you are differentiating between thr industry mean (average) reduction, what you're terming "absolute", versus any one individual's actual likely reduction benefit (what you refer to as relative)?

At any rate, I tried to find data that delineated the mean (the average), the mode and the median for the purported reduction benefit for taking an aromatase inhibitor as those would be more valuable than the mean/average. Since the mean blends a large population of people with vastly different genetics, health profiles, nutrition, access to healthcare choices, etc. And one's own likely benefit can be greater or less.

I've not seen any hard data of recurrence risk rates by age, by cancer tumor profile, though I know that there are some rough estimates. The problem with breast cancer among older women is that there is so little quality data in part because there has historically been little to no real screening for breast cancer among women over 60-65 until relatively recently.