Abstract
Post-progression survival affects overall survival (OS) in patients with HER2-negative advanced breast cancer (HER2-ABC); thus, the optimal choice of first-line chemotherapy (1LCT) remains controversial. We investigated patients with HER2-ABC focusing on their sensitivity to 1LCT. We retrospectively analyzed patients with HER2-ABC who received 1LCT between January 2011 and December 2016 in three participating institutions. We identified 149 patients in the shorter and 152 patients in the longer time to treatment failure (TTF) groups. The median OS was significantly longer in the longer TTF group (hazard ratio [HR] 0.44, P < 0.001, log-rank). In the shorter TTF group, OS of patients who received paclitaxel plus bevacizumab (PB) therapy was significantly inferior to that of those who received chemotherapy other than PB (HR 2.57, P < 0.001, log-rank), and subsequent eribulin therapy significantly improved OS from 1LCT initiation (Wilcoxon P < 0.001); multivariate analyses showed that 1LCT PB therapy was an independent risk factor for poorer OS (HR 2.05, P = 0.003), while subsequent eribulin therapy was an independent prognostic factor for better OS (HR 0.56, P = 0.004). OS was significantly poorer in patients with HER2-ABC with a shorter duration of 1LCT, including PB therapy, while subsequent eribulin therapy improved OS.
Highlights
Post-progression survival affects overall survival (OS) in patients with HER2-negative advanced breast cancer (HER2-ABC); the optimal choice of first-line chemotherapy (1LCT) remains controversial
A moderately significant correlation was observed between treatment failure (TTF) and OS, and OS was significantly poorer in the shorter TTF group than in the longer TTF group
In the shorter TTF group, first-line plus bevacizumab (PB) therapy was associated with the significantly inferior OS than conventional chemotherapy, and subsequent eribulin was significantly associated with better OS
Summary
Post-progression survival affects overall survival (OS) in patients with HER2-negative advanced breast cancer (HER2-ABC); the optimal choice of first-line chemotherapy (1LCT) remains controversial. The new agents have improved progression-free survival (PFS), only a few agents and regimens have demonstrated an improvement in overall survival (OS) in the first-line setting This difference is because OS can be affected by the response to subsequent therapies, increased tumor load, and relatively longer post-progression s urvival[1,2], and several reports have indicated that PFS is not a good surrogate for OS3,4. Our previous s tudy[11] showed that PB therapy as 1LCT improved the overall response rate (ORR) and time to treatment failure (TTF) compared with conventional chemotherapy in patients with HER2- ABC after propensity score matching. We focused on the clinical course of patients with a short-term response to first-line treatment
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