Abstract
BackgroundStudy aimed to characterise treatment and outcomes for patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC) within a large regional cancer centre, as a benchmark for evaluating real-world impact of novel therapies.MethodsRetrospective longitudinal cohort, using electronic patient records of adult females with a first diagnosis of HR+/HER2- MBC January 2012–March 2018.ResultsOne hundred ninety-six women were identified with HR+/HER2- MBC. Median age was 67 years, 85.2% were post-menopausal and median time between primary diagnosis and metastasis was 5.4 years. Most (75.1%) patients received endocrine therapy as first line systemic treatment (1st LoT); use of 1st LoT chemotherapy halved between 2012 and 2017. Patients receiving 1st LoT chemotherapy were younger and more likely to have visceral metastasis (p < 0.01). Median OS was 29.5 months and significantly greater for patients with exclusively non-visceral metastasis (p < 0.01). The adjusted hazard ratio for death of patients with visceral (or CNS) metastasis was 1.91 relative to those with exclusively non-visceral metastasis.ConclusionsDiverse endocrine therapies predominate as 1st LoT for patients with HR+/HER2- MBC, chemotherapy being associated with more aggressive disease in younger patients, emphasising the importance of using effective and tolerable therapies early.
Highlights
Study aimed to characterise treatment and outcomes for patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC) within a large regional cancer centre, as a benchmark for evaluating real-world impact of novel therapies
Where HR or human epidermal growth factor receptor 2 (HER2) receptor status was missing in coded fields, past treatment with endocrine therapy was used as a proxy for HR+ status and these patients were included; treatment with trastuzumab was used as a proxy for HER2+ status and these patients were excluded
Over this 75-month period, 464 patients were identified with a new diagnosis of locally advanced Breast cancer (BC) or MBC, 318 of whom (68.5%) had HR+/HER2- disease
Summary
Study aimed to characterise treatment and outcomes for patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC) within a large regional cancer centre, as a benchmark for evaluating real-world impact of novel therapies. Clinical decisions regarding systemic anticancer treatment (SACT), are usually influenced by expression of oestrogen/progesterone hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status [2] along with patient preference, prior therapy (and tolerability), comorbidities, and organ function [3]. Where rapidly progressing visceral disease is absent, the UK National Institute for Health and Care Excellence recommends endocrine therapy as firstline systemic treatment (1st LoT) for such patients [3], mirroring international recommendations [5,6,7]. The NCCN recommend continuing endocrine therapy for a maximum of 3 regimens until progression or unacceptable toxicity [7]
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