Abstract

BackgroundIn this study, we observe the patterns initial palliative treatment for premenopausal patients with HR-positive/HER2-negative MBC and determine if nonadherence to clinical guidelines are associated with worse clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) in the South Korean population.MethodsA retrospective review was performed for premenopausal patients diagnosed with HR-positive/HER2-negative MBC between October 1997 and May 2016 who received palliative systemic treatments at a large tertiary medical center. Survival outcomes were analyzed according to the palliative treatment received prior to disease progression.ResultsThe review identified a total of 272 premenopausal patients meeting study criteria, whose median age was 39 years. Endocrine therapy was the initial treatment in 137 patients (Group 1) with chemotherapy as initial treatment in 135 patients. In the latter group, chemotherapy was continued in 78 patients (Group 2), whereas chemotherapy was switched to endocrine treatment in 57 patients prior to any disease progression (Group 3). Both PFS and OS were significantly longer for chemotherapy-endocrine therapy (median PFS 18.2 months and OS 85.2 months) than for chemotherapy-alone (median PFS 12.6 months and OS 45.5 months) or endocrine therapy-alone (median PFS 7.0 months and OS 57.3 months) (all p values < 0.01). In multivariate analysis, chemotherapy-endocrine therapy was an independent predictive value for improved PFS and OS (hazard ratio [HR] 0.33, 95% CI 0.20–0.52, p < 0.001; HR 0.38, 95% CI 0.19–0.73, p = 0.004).ConclusionsIn our study population, chemotherapy alone was not objectively inferior to endocrine therapy as the initial palliative treatment. In addition, chemotherapy followed by endocrine therapy was associated with objective higher response rate than endocrine therapy alone. Further studies should explore the relationship between non-adherent treatment patterns and patient outcomes across the largely premenopausal breast cancer populations across Asian countries.

Highlights

  • In this study, we observe the patterns initial palliative treatment for premenopausal patients with HRpositive/HER2-negative metastatic breast cancer (MBC) and determine if nonadherence to clinical guidelines are associated with worse clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) in the South Korean population

  • Chemotherapy followed by endocrine therapy was associated with objective higher response rate than endocrine therapy alone

  • Real-world practicing patterns differ from the guidelines with a considerable portion of patients with hazard ratio (HR)-positive/ HER2-negative MBC still receiving initial palliative chemotherapy rather than endocrine therapy, with non-adherent practice resulting in worse outcomes [7]

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Summary

Introduction

We observe the patterns initial palliative treatment for premenopausal patients with HRpositive/HER2-negative MBC and determine if nonadherence to clinical guidelines are associated with worse clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) in the South Korean population. Hormone receptor positive (HR-positive) subtype represents the majority of the patients with breast cancer (60–75%) [3], and early stage HR-positive patients receive adjuvant endocrine therapy after curative aim of treatment. About 30% of early HR-positive breast cancer develops into metastatic disease over time, and de novo metastatic breast cancer represents about 5–10% of all breast cancer [4]. Real-world practicing patterns differ from the guidelines with a considerable portion of patients with HR-positive/ HER2-negative MBC still receiving initial palliative chemotherapy rather than endocrine therapy, with non-adherent practice resulting in worse outcomes [7]

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