Abstract
PurposeThe aim of this study was to identify factors associated with progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer (MBC) treated with eribulin in a real-world setting, to improve information provision in those considering treatment.MethodsPatients treated with eribulin for MBC at The Christie NHS Foundation Trust, Manchester, UK, between August 2011 and December 2018 were included (n = 439). Data were collected by retrospective review of medical records and electronic prescribing systems. Factors such as biological subtype, distant recurrence-free interval, previous lines of chemotherapy and the ‘average duration of previous treatment lines’ (ADPT) (calculated as: (date of initiation of eribulin–date of MBC) / the number of previous treatment lines in the metastatic setting) were evaluated for prognostic impact using Cox proportional hazards regression.ResultsIn the full cohort, the median PFS and OS were 4.1 months (95% CI 3.7–4.4) and 8.6 months (95% CI 7.4–9.8), respectively. Outcomes were significantly inferior for those with triple-negative breast cancer (TNBC) (n = 92); PFSTNBC: 2.4 months (95% CI 2.1–3.0), p = < 0.001 and OSTNBC: 5.4 months (95% CI 4.6–6.6), p = < 0.001. ADPT was the only factor other than subtype significantly associated with PFS and OS. Longer ADPT was also significantly associated with PFS and OS in those with TNBC. For example, women in the lowest ADPT tertile (< 5.0 months) achieved a median OS of only 4.3 months, whereas those in the upper ADPT tertile (> 8.7 months) had a median OS of 12.1 months (p = 0.004).ConclusionOur results indicate that the ADPT lines is an important factor when predicting the outcome with eribulin chemotherapy in a palliative setting and that quantitative guidance on the likely PFS and OS with treatment can be provided using ADPT. Validation in additional cohorts is warranted.
Highlights
Breast cancer is the most common cancer in women with approximately 1.7 million new cases per year worldwide [1]
Our cohort was more heavily pretreated when compared to Study 301 [4] and 41 patients (9.3%) received ≤ 1 full cycle of eribulin and had Progression-free survival (PFS) and overall survival (OS) of only 0.6 months and 1.4 months, respectively
Other trials based on real-world data including > 100 patients report a wider spread of results for PFS (3.3–6.1 months) and OS (10.6–31.8 months) [7–14]
Summary
Breast cancer is the most common cancer in women with approximately 1.7 million new cases per year worldwide [1]. In Study 301, patients with MBC of all subtypes previously treated with anthracyclines and taxanes were assigned 1:1 to receive eribulin or capecitabine as 1st-, 2nd- or 3rd-line therapy. In this trial, PFS was 4.1 months and no significant difference in OS was seen between the 2 groups (15.9 months vs 14.5 months, p = 0.056) [4]. A pooled analysis of EMBRACE and Study 301 has been published (n = 1864; eribulin n = 1062, TPC or capecitabine n = 802) with OS data favouring eribulin (15.2 months vs 12.8 months, p = 0.003) and a similar positive effect seen across the different subtypes [6]
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