

Key results of a multicenter, non-interventional, retrospective study of Ixabepilone therapy in routine clinical practice in patients with locally advanced or metastatic breast cancer after failure of previous therapy NIRMA
https://doi.org/10.33667/2078-5631-2025-11-80-88
Abstract
Chemotherapy is an integral part of drug treatment of patients with metastatic breast cancer (mBC), regardless of the biological subtype of the tumor, and the availability of a large number of effective drug treatment options can significantly increase life expectancy. Intensive neoadjuvant and adjuvant chemo ± targeted therapy, as well as pretreatment for the metastatic form of the disease, can significantly reduce the effectiveness of subsequent lines of chemotherapy, which complicates the choice of treatment options. That is why the results of modern observational studies of real clinical practice are of exceptional value. Ixabepilone is a semi-synthetic analogue of epothilone B, used for locally advanced or metastatic breast cancer when previous therapy is ineffective.
The purpose of this study is to evaluate the efficacy and tolerability of ixabepilone alone and in combination with chemoor target drugs in real clinical practice in the Russian Federation.
Methods. A multicenter, non-interventional, retrospective study of ixabepilone therapy in routine clinical practice in patients with locally advanced or metastatic breast cancer with ineffectiveness of previous therapy NIRMA (CLO1418141) included 101 patients who received ixabepilone as monotherapy and in various combinations in the 1st and subsequent lines of therapy from 01.01.2021 to 31.12.2023 in 15 oncological institutions of the Russian Federation.
Results. The median of previous therapy lines for metastatic disease was 3. Ixabepilone therapy was administered alone (n=58), in combination with capecitabine (n=30), or in combination with trastuzumab (n=13). The median PFS was 5.77 months. [95 % CI 5.31–6.07] The objective response rate was 35.64 % (36/101), including 1 complete and 35 partial responses. Disease control rate in intensively pre-treated patients with mBC reached 84.16 % (84/101). Adverse events (AE) of any severity were recorded in 25.74 % of cases. The main adverse events with ixabepilone were neutropenia and peripheral polyneuropathy. In no case did toxicity lead to early discontinuation of treatment or death. In patients with mBC progression after anthracyclines and taxanes, the combination of ixabepilone with capecitabine or ixabepilone with trastuzumab demonstrates extremely high disease control rates in modern Real Clinical Practice (RCP). Ixabepilone monotherapy is an option of choice in patients with breast cancer progression after anthracyclines, taxanes and capecitabine.
About the Authors
E. V. ArtamonovaRussian Federation
Artamonova Elena V. - DM Sci (habil.), professor, head of Dept of Antitumor Drug Therapy No. 1 of Dept of Drug Treatment N.N. Blokhin National Medical Investigation Centre of Oncology, professor at Dept of Oncology and Radiation Therapy N.I. Pirogov Russian National Research Medical University, head of Dept of Oncology and Thoracic Surgery M.F. Vladimirsky Moscow Regional Research Clinical Institute.
Moscow
E. P. Anokhina
Russian Federation
Anokhina Ekaterina P. - oncologist of Chemotherapeutic Day Hospital.
Ulyanovsk
K. G. Babina
Russian Federation
Babina Ksenia G. - oncologist, head of Chemotherapy (Antitumor Drug Therapy) Dept. AuthorID: 1036669.
Volgograd
N. P. Basova
Russian Federation
Basova Natalia P. - deputy chief physician.
Yoshkar-Ola
S. P. Deminova
Russian Federation
Dyominova Svetlana P. - oncologist of the highest qualification category, head of Dept of Antitumor Drug Chemotherapy.
Khabarovsk
R. A. Zhukov
Russian Federation
Zukov Ruslan A. - DM Sci (habil.), professor, head of Dept of Oncology and Radiation Therapy with a Postgraduate Course Krasnoyarsk State Medical University named after Professor V. F. Voyno-Yasenetsky, chief physician Krasnoyarsk Regional Clinical Oncology Dispensary named after A. I. Kryzhanovsky, chief oncologist of the Ministry of Health of Krasnoyarsk Krai.
Krasnoyarsk
F. G. Ivanova
Russian Federation
Ivanova Feodosia G. - PhD Med, head of Drug Therapy Dept Yakutsk Republican Oncology Dispensary, chief oncologist of the Ministry of Health of the Republic of Sakha (Yakutia), associate professor at Dept NorthEastern Federal University named after M. K. Ammosov.
Yakutsk
M. G. Leonov
Russian Federation
Leonov Mikhail G. - DM Sci (habil.), oncologist of the highest category, chief physician, chief oncologist of the Health Dept of the Novorossiysk City Administration.
Novorossiysk
D. M. Ponomarenko
Russian Federation
Ponomarenko Dmitry M. - PhD Med, oncologist of the highest qualification category, head of Dept of Antitumor Drug Chemotherapy.
Irkutsk
E. S. Sadakova
Russian Federation
Sadakova Ekaterina S. - oncologist at Chemotherapeutic Day Hospital.
Kirov
A. V. Sultanbaev
Russian Federation
Sultanbaev Alexander V. - PhD Med, head of Dept of Antitumor Drug Therapy.
Ufa
A. V. Khorinko
Russian Federation
Khorinko Andrey V. - head of Chemotherapy Dept No. 1.
Perm
A. V. Shkradyuk
Russian Federation
Shkradyuk Alexander V. - head of Dept of Antitumor Drug Therapy No. 2, chief specialist of the Ministry of Health of the Republic of Crimea for Antitumor Drug Therapy.
Simferopol
D. Yu. Yukalchuk
Russian Federation
Yukalchuk Denis Yu. - head of Day Hospital at the Outpatient Dept (Antitumor Drug Chemotherapy), oncologist of the highest qualification category.
Irkutsk
M. A. Yavorskaya
Russian Federation
Yavorskaya Marina A. - deputy chief physician for Medical Care.
Sochi
A. S. Shatokhina
Russian Federation
Shatokhina Alina S. - oncologist of the highest qualification category, head of Dept of Antitumor Drug Therapy No. 3. AuthorID: 1244820
Krasnodar
Yu. Yu. Makarycheva
Russian Federation
Makarycheva Yulia Yu. - clinical pharmacologist.
Samara
T. Yu. Dergacheva
Russian Federation
Dergacheva Tatyana Yu. - director of Dept of Medical Support for Oncology Products.
Moscow
M. A. Egorova
Russian Federation
Egorova Maria A. - senior medical advisor.
Moscow
A. V. Petkova
Russian Federation
Petkova Anna V. - head of Biostatistics Group.
Moscow
E. V. Kondrashova
Russian Federation
Kondrashova Ekaterina V. - PhD Pharm, medical advisor.
Moscow
M. Yu. Samsonov
Russian Federation
Samsonov Mikhail Yu. - PhD Med, associate professor at Pharmacology DeptI. M. Sechenov First Moscow State Medical University (Sechenov University), medical director JSC R-Pharm (R-Pharm Group of Companies).
Moscow
References
1. Artamonova E. V. Drug treatment of metastatic breast cancer, Breast cancer: a guide for doctors / edited by D. A. Ryabchikov, A. V. Petrovsky. Moscow: GEOTAR-Media, 2023. 400 p.: ill. (In Russ.). DOI: 10.33029/9704-7400-0-BRC-2023-1-400, ISBN 978-5-9704-7499-0. P. 251–278.
2. Rugo H, Mayer I, Conte P. et al. Prevalence of PIK3CA mutations in patients with hormone receptor-positive, human epidermal growth factor-2-negative advanced breast cancer from the SOLAR-1 trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res. 2019; 79 (13 Suppl): Abstract nr CT142.
3. Rugo HS, Lerebours F, Ciruelos E. et al. Alpelisib (ALP) + fulvestrant (FUL) in patients (pts) with PIK3CA-mutated (mut) hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC) previously treated with cyclin-dependent kinase 4/6 inhibitor (CDKi) + aromatase inhibitor (AI): BYLieve study results. J Clin Oncol. 2020; 38 (Suppl. 15): Abstract 1006.
4. Hamdy Azim, Nagi S. El Saghir, Yoon-Sim Yap, Yesim Eralp, Seock-Ah Im, Singh Malwinder, Hikmat Abdel-Razeq, Sudeep Gupta, Elena Artamonova, Julie Rihani, Teresa Delgar Alfaro, Jiwen Wu, Huilin Hu, Melissa Gao, Yen-Shen Lu. RIGHT Choice Visceral crisis Subgroup Analysis. Ann Oncol. 2023; 34: S 350–S 351, 402P DOI: 10.1016/j.annonc.2023.09.579 https://www.esmo.org/meeting-calendar/esmo-congress-2023/abstracts
5. Artamonova E. V., Vladimirova L. Yu., Zhukova L. G., Orlova R. V., Karabina E. V., Kovalenko E. I., Zhikhorev R. S., Nogina E. N., Tyugina Ya.A., Shkradyuk A. V., Yukalchuk D. Yu. Interim data from the PROSPERITY study, a prospective observational study to assess clinical outcomes, treatment regimens, and characteristics of patients with HR+/ HER2-advanced breast cancer receiving treatment with ribociclib, alpelisib, endocrine therapy, or chemotherapy in routine clinical practice in Russia.ruSSCO Newspaper. 2023; 3: 11–12. (In Russ.).
6. Swain S, Baselga J., Kim S. et al. Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive Metastatic Breast Cancer. New England J med. 372 (2015): 724–734. DOI: 10.1016/S1470–2045(19)30863-0
7. Erika Hamilton; Komal Jhaveri; Sherene Loi; Carey Anders; Peter Schmid; Konstantin Penkov; Elena Artamonova; Lyudmila Zhukova; Daniil L. Stroyakovsky; Dinesh Chandra Doval; Rafael Villanueva; Flavia Michelini; Sarat Chandarlapaty; Matt Wilson; Sarice R. Boston; Adam Konpa; Shoubhik Mondal; Fabrice Andre. Abstract PD 18–11: Dose-Expansion Study of Trastuzumab Deruxtecan as Monotherapy or Combined with Pertuzumab in Patients with Metastatic Human Epidermal Growth Factor Receptor 2-Positive (HER2+) Breast Cancer in DESTINY-Breast07 (DB-07). Cancer Res. 2023; 83 (5_Supplement): PD 18–11. https://doi.org/10.1158/1538–7445.SABCS22-PD18–1
8. Lubennikova E. V., Ganshina I. P., Manukyan M. Sh., Tyurin I. E., Artamonova E. V. Expanding the possibilities of therapy for HER2-low metastatic breast cancer: experience with trastuzumab deruxtecan in aggressive luminal HER2-low breast cancer. Medical Council. 2024; 18 (10): 66–73. (In Russ.). https://doi.org/10.21518/ms2024-246
9. Manich C. S., Modi S., Krop I., Park Y. H., Kim S. B., Tamura K. et al. 279P trastuzumab deruxtecan (T-DXd) in patients with HER2-positive metastatic breast cancer (MBC): updated survival results from a phase II trial (DESTINY-Breast01). Annals of Oncology. 2021; 32: S 485–S 486. https://doi.org/10.1016/j.annonc.2021.08.562
10. Saura Manich C., S. Modi, I. Krop, Y. H. Park, S. Kim, K. Tamura et al. Trastuzumab deruxtecan (T-DXd) in patients with HER2-positive metastatic breast cancer (MBC): Updated survival results from a phase II trial (DESTINY-Breast01). Annals of Oncology. 2021; 32 (suppl_5): S 457–S 515. DOI: 10.1016/annonc/annonc689
11. André F, Hee Park Y, Kim SB, Takano T, Im SA, Borges G. et al. Trastuzumab deruxtecan versus treatment of physician’s choice in patients with HER2-positive metastatic breast cancer (DESTINY-Breast02): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2023; S 0140–6736 (23) 00725-0. DOI: 10.1016/S0140-6736(23)00725-0
12. Tyulyandin S. A., Artamonova E. V., Zhigulev A. N., Zhukova L. G., Koroleva I. A., Parokonnaya A. A., Semiglazova T. Yu., Stenina M. B., Frolova M. A. Breast cancer. Practical recommendations RUSSCO. Part 1.2. Malignant tumors. 2024; 14 (3 s2): 32–81. (In Russ.).
13. Bardia et. al. 2017. J Clin Oncol 35 (19): 2141–2148.
14. Bardia et. al. 2021. NEJM 384 (16): 1529–1541.
15. Rugo et. al. 2022. J Clin Onc 40 (29): 3375–3376.
16. Rugo et. al. 2023. The Lancet 402 (10411): 1423–1433.
17. Датопотамаба дерукстекан
18. Im, S. A., Gennari, A., Park, Y. H., Kim, J. H., Jiang, Z. F., Gupta, S., … & Harbeck, N. (2023). Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, staging and treatment of patients with metastatic breast cancer. ESMO open. 8 (3): 101541. DOI: 10.1016/j.esmoop.2023.101541
19. ESMO Breast Cancer Pocket Guideline 2024. URL: https://interactiveguidelines.esmo.org/esmo-web-app/toc/index.php?subjectAreaID=8&loadPdf=1
20. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast Cancer. Version 5.2024 – October 15, 2024. URL: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
21. Fossati R., Confalonieri C., Torri V. et al. Cytotoxic and hormonal treatment of metastatic breast cancer: A systematic review of published randomized trials involving 31,510 women. J Clin Oncol. 1998; 16: 3439–3460.
22. Cardoso F., Bedard Ph. L., Winer E. P. et al. International Guidelines for Management of Metastatic Breast Cancer: Combination vs Sequential Single-Agent Chemotherapy. J Natl Cancer Inst. 2009; 101: 1174–1181.
23. O’Shaughnessy J., Miles D., Vukelja S. et al. Superior Survival with Capecitabine Plus Docetaxel Combination Therapy in Anthracycline-Pretreated Patients with Advanced Breast Cancer: Phase III Trial Results. J Clin Oncol. 2002; 15: 2812–2823.
24. Albain K. S., Nag S., Calderillo-Ruiz G. et al. Global phase III study of gemcitabine plus paclitaxel (GT) vs. paclitaxel (T) as frontline therapy for metastatic breast cancer (MBC): First report of overall survival (abstract 510). Proc. ASCO. 2004; 23: 5 (abstract 510).
25. Martin M., Ruiz A., Munoz M. et al. Gemcitabine plus vinorelbine versus vinorelbine monotherapy in patients with metastatic breast cancer previously treated with anthracyclines and taxanes: final results of the phase III Spanish Breast Cancer Research Group (GEICAM) trial. Lancet Oncol. 2007; 8 (3): 219–225.
26. V. F. Semiglazov, P. V. Krivorotko, T. Yu. Semiglazova, E. V. Artamonova, A. S. Artemyeva, et al. I St. Petersburg International Consensus on the Diagnosis and Treatment of Breast Cancer «White Nights 2024». Oncology Issue. (In Russ.).
27. Fojo AT, Menefee M. Microtubule targeting agents: basic mechanisms of multidrug resistance (MDR). Semin Oncol. 2005; 32: S 3–8.
28. Orr GA, Verdier-Pinard P, McDaid H, Horwitz SB. Mechanisms of Taxol resistance related to microtubules. Oncogene. 2003; 22: 7280–95.
29. Paradiso A, Mangia A, Chiriatti A. et al. Biomarkers predictive for clinical efficacy of taxol-based chemotherapy in advanced breast cancer. Ann Oncol. 2005; 16 (Suppl. 4): iv14–19.
30. Martello LA, Verdier-Pinard P, Shen HJ. et al. Elevated levels of microtubule destabilizing factors in a Taxol-resistant/dependent A549 cell line with an β-tubulin mutation. Cancer Res. 2003; 63: 1207–13.
31. Kamath K, Wilson L, Cabral F. et al. Beta III-tubulin induces paclitaxel resistance in association with reduced effects on microtubule dynamic instability. J Biol Chem. 2005; 280: 12902–7.
32. Kavallaris M, Burkhart CA, Horwitz SB, Antisense oligonucleotides to class III beta-tubulin sensitize drug-resistant cells to Taxol. Br J Cancer. 1999; 80: 1020–25.
33. Kowalski RJ, Giannakakou P, Hamel E. Activities of the microtubule-stabilizing agents epothilones A and B with purified tubulin and in cells resistant to paclitaxel (TaxolR). J Biol Chem. 1997; 272: 2534–41.
34. McDaid HM, Mani S, Shen HJ et al. Validation of the pharmacodynamics of BMS-247550, an analogue of epothilone B, during a phase I clinical study. Clin Cancer Res. 2002; 8: 2035–43.
35. Lee JJ, Swain SM. Development of novel chemotherapeutic agents to evade the mechanisms of multidrug resistance (MDR). Semin Oncol. 2005; 32: S 22–6.
36. Roche H, Yelle L, Cognetti F. et al. Phase II clinical trial of ixabepilone (BMS-247550), an epothilone B analog, as first-line therapy in patients with metastatic breast cancer previously treated with anthracycline chemotherapy. J Clin Oncol. 2007; 25: 3415–20.
37. Denduluri N, LowJA, Lee JJ. et al. Phase II trial of ixabepilone, an epothilone B analog, in patients with metastatic breast cancer previously untreated with taxanes. J Clin Oncol. 2007; 25: 3421–7.
38. Low JA, Wedam SB, Lee JJ. et al. Phase II clinical trial of ixabepilone (BMS-247550), an epothilone B analog, in metastatic and locally advanced breast cancer. J Clin Oncol 2005; 23: 2726–34.
39. Thomas E, Tabernero J, Fornier M. et al. Phase II clinical trial of ixabepilone (BMS-247550), an epothilone b analog, in patients with taxane-resistant metastatic breast cancer. J Clin Oncol. 2007; 25: 3399–406.
40. Perez EA, Lerzo G, Pivot X. et al. Efficacy and safety of ixabepilone (BMS-247550) in a phase II study of patients with advanced breast cancer resistant to an anthracycline, a taxane, and capecitabine. J Clin Oncol. 2007; 25: 3407–3414.
41. Thomas ES, Gomez HL, Li RK. et al. Ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol. 2007; 25: 5210–7.
42. Hortobagyi GN, Perez E, Vdoljak E et al. Analysis of overall survival among patienys with metastatic breast cancer receiving either ixabepilone plus capecitabine or capecitabine alone and review of results from two randomized phase III trials. ASCO Breast. 2008,– Аbstr. 186.
43. Jassem J, Fein L, Karwal M. et al. Ixabepilon plus capecitabine in advanced breast cancer patients with early relapse after adjuvant anthracyclines and taxanes: a pooled subset analysis of two phase III stadies. The Breast. 2012; 21: 89–94.
44. https://adilet.zan.kz/rus/docs/H16EV000078
45. https://www.definitivehc.com/resources/glossary/real-world-data-real-world-evidence
46. https://www.ispor.org/heor-resources/about-heor/top-10-heor-trends
Review
For citations:
Artamonova E.V., Anokhina E.P., Babina K.G., Basova N.P., Deminova S.P., Zhukov R.A., Ivanova F.G., Leonov M.G., Ponomarenko D.M., Sadakova E.S., Sultanbaev A.V., Khorinko A.V., Shkradyuk A.V., Yukalchuk D.Yu., Yavorskaya M.A., Shatokhina A.S., Makarycheva Yu.Yu., Dergacheva T.Yu., Egorova M.A., Petkova A.V., Kondrashova E.V., Samsonov M.Yu. Key results of a multicenter, non-interventional, retrospective study of Ixabepilone therapy in routine clinical practice in patients with locally advanced or metastatic breast cancer after failure of previous therapy NIRMA. Medical alphabet. 2025;(11):80-88. (In Russ.) https://doi.org/10.33667/2078-5631-2025-11-80-88