Diagnosis Of Metastatic Breast Cancer Research Articles

Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans.

High-deductible health plan (HDHP) enrollment is expanding rapidly and might substantially increase out-of-pocket (OOP) payment burden. We examined trends in total and OOP health service expenditures overall and by insurance coverage type among women with metastatic breast cancer. We used a longitudinal time series design to examine measures among 5364 women with metastatic breast cancer insured by a large US health insurer from 2004 to 2011. We measured outcomes during the 12 months after a first identified metastatic breast cancer diagnosis and required women to have at least 6 months of prior enrollment. We plotted enrollment measures and adjusted total and OOP spending. We fit trend lines using linear autoregressive models. Between 2004 and 2011, the percentage of women with metastatic breast cancer enrolled in employer-mandated HDHPs increased from 8 to 23% while the percentage enrolled in employer-mandated low-deductible plans (LDHPs) decreased from 69 to 37%. Over the same time period, estimated annual inflation-adjusted total health service spending among women with metastatic breast cancer whose employers only offered HDHPs or LDHPS increased from $96,899 to $104,688 (increase of $1197 per year; 95% confidence interval [CI]: $47,$2,348). Corresponding OOP spending values among these women with employer-mandated deductible levels were $4,496 and $5,151 ($91 per year trend; 95% CI -$13,$195). From 2004-2011, women in HDHPs and LDHPs had unchanged annual OOP spending, estimated at of $6642 (95% CI $6,268,$7016) and $4,247 (95% CI $3956,$4538), respectively. Thus, women in HDHPs experienced 55% (44%, 66%) more OOP spending than women in LDHP. OOP spending among women with metastatic breast cancer and employer-mandated deductible levels was 55% higher among HDHP than LDHP members, and employer-mandated HDHP enrollment increased substantially from 2004 to 2011. Stakeholders and policymakers should design health plans that protect financially vulnerable cancer patients from high OOP costs.

Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort

AimReal-life analysis of overall survival (OS) trends among metastatic breast cancer (MBC) patients may help define medical needs and evaluate the impact of public health investments. The present study aimed to evaluate the independent impact of the year of MBC diagnosis on OS in the Epidemio-Strategy-Medical-Economical (ESME)-MBC cohort. MethodsESME-MBC (NCT03275311) is a French, national, multicentre, observational cohort including 16,702 consecutive newly diagnosed MBC patients (01 January 2008–31 December 2014). Of 16,680 eligible patients, 15,085 had full immunohistochemistry data, allowing classification as hormone receptor–positive and HER2-negative (HR+/HER2–, N = 9907), HER2-positive (HER2+, N = 2861) or triple-negative (HR–/HER2–, N = 2317) subcohorts. Multivariate analyses of OS were conducted among the full ESME cohort and subcohorts. ResultsMedian OS of the whole cohort was 37.22 months (95% confidence interval [CI], 36.3–38.04). Year of diagnosis was an independent predictor of OS (hazard ratio 0.98 [95% CI, 0.97–1.00], P = .01) together with age, subtype, disease-free interval, visceral metastases and number of organs involved. Median OS of HR+/HER2–, HER2+ and HR–/HER2– subcohorts was, respectively, 42.12 (95% CI, 40.90–43.10), 44.91 (95% CI, 42.51–47.90) and 14.52 (95% CI, 13.70–15.24) months. Year of diagnosis was a strong independent predictor of OS in HER2+ subcohort (hazard ratio 0.91 [95% CI, 0.88–0.94], P < .001), but not in HR+/HER2– nor HR–/HER2– subcohorts (hazard ratio 1.00 [95% CI, 0.98–1.01], P = .80 and 1.00 [95% CI, 0.97–1.02], P = .90, respectively). ConclusionsThe OS of MBC patients has slightly improved over the past decade. However, this effect is confined to HER2+ cases, highlighting the need of new strategies in the other subtypes.

Abstract P6-08-10: Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life "ESME" cohort

Abstract Background Young age is a known poor prognosis factor in early stage breast cancer (BC). Its value is less documented for metastatic BC (MBC). Guidelines state that age should not guide the treatment strategy. We used the ESME database to evaluate the impact of age at MBC diagnosis on overall survival (OS). Patients and Methods ESME is a unique national cohort, collecting retrospective data using clinical trial-like methodology. It included all consecutive MBC patients (pts) who initiated at least 1 treatment in one of the 18 participating French cancer centers between 01/01/2008 and 12/31/2014. The database was locked on 12/8/2016. Primary objective were the comparisons of MBC characteristics between age groups (&amp;lt;40, 40 to 60 and &amp;gt;60 years (y)) and the evaluation of the impact of age at MBC diagnosis on OS. Interaction between age and tumor subtype was tested using a Cox regression model. ResultsAmong 16 703 included pts, 1539 had no information on tumor receptors (ER/PR/HER2) and 682 had an exclusion criteria (unknown age, men or other cancer in the last 5y), leaving 14 482 for analysis. At the onset of MBC, 902 pts (6.2%), 6269 (43.3%) and 7311 (50.5%) were &amp;lt;40y, 40y to 60y and older than 60y respectively. Median follow-up was 54.8 months. Pts &amp;lt;40 had significantly more aggressive presentations than other age groups: more HER2+ (26.5%), and triple negative (26.4%) subtypes, more visceral involvement (57.1%), and shorter time to metastasis (26.9% between 6 to 24 months) (all p-value vs other age groups &amp;lt;0.0001). MBC characteristics according to age groups Age at MBC diagnosis (years)p-value &amp;lt;4040-60&amp;gt;60 Tumor subtype &amp;lt;0.0001HR+/HER2-425 (47.12)3816 (60.87)5262 (71.97) HR-/HER2-238 (26.39)1126 (17.96)884 (12.09) HER2+239 (26.5)1327 (21.17)1165 (15.93) Type of metastasis, N(%) &amp;lt;0.0001Bone only219 (24.31)1832 (29.23)2367 (32.41) Non visceral168 (18.65)1046 (16.69)1314 (17.99) Visceral514 (57.05)3389 (54.08)3623 (49.6) Time to first metastasis (months), N(%) &amp;lt;0.0001&amp;lt; 6304 (33.74)1882 (30.1)2107 (28.9) [6-12[65 (7.21)241 (3.85)209 (2.9) [12-24[177 (19.64)760 (12.15)564 (7.7) ≥24355 (39.4)3370 (53.89)4416 (60.53) Number of metastatic sites, N(%) 0.51 site709(78.6)4948 (78.93)5805 (79.4) 2 sites163(18.07)1130 (18.03)1313(17.96) ≥3 sites30(3.33)191 (3.05)193 (2.64) Overall, median OS was identical in the different age groups: 39.1, 41.1 and 39.8 months for pts &amp;lt;40, 40-60 and &amp;gt;60, respectively (p=0.2). Tumor subtype and age showed a significant interaction on OS (p&amp;lt;0.0001), especially among HER2+ MBC Overall survival (months) according to tumor subtypes and age groups Age groups (years)p-value (log-rank)Tumor subtype&amp;lt;4040-60&amp;gt;60 HR+/HER2-46,4 (CI 95% 40.5-55.4)47,8 (CI 95% 46-50)44,2 (CI 95% 42.1-46.3)0.0023HER2+60,7 (CI 95% 45.6-76.4)50,4 (CI 95% 46.3-56.3)44 (CI 95% 38.8-48.9)&amp;lt;0.0001Triple negative14 (CI 95% 11.5-16.5)14,7 (CI 95% 13.7-15.9)15,7 (CI 95% 14.6-17.1)0.01 . Anti-HER2 with first-line treatment was given preferentially to young pts: 86.6, 81.9 and 74.9%for pts &amp;lt;40, 40-60 and &amp;gt;60, respectively (p&amp;lt;0.0001). Conclusion At onset of MBC, young age was associated with more aggressive presentations, however with no global impact on OS. Pts &amp;lt;40 with HER2+ disease carried a better prognosis, maybe related to therapy. Citation Format: Frank S, Tchokothe C, Carton M, Mouret-Fourme E, Dubot C, Campone M, Pistilli B, Dalenc F, Mailliez A, Levy C, D'Hondt V, Debled M, Leheurteur M, Coudert B, Perrin C, Gonçalves A, Uwer L, Ferrero J-M, Eymard J-C, Petit T, Mouret-Reynier M-A, Guesmia T, Bachelot T, Robain M, Cottu P. Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life "ESME" cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-10.

Abstract P6-14-06: Oral etoposide (VP-16) in heavily pre-treated metastatic breast cancer: A multicenter national observational study

Abstract Background 20-30% of breast cancer (BC) patients will develop distant metastases. Despite important improvement achieved in the management of metastatic BC (MBC), median overall survival (OS) still ranges from 14 to 50 months, depending on tumor subtypes. Patients often receive many successive lines of therapy over the course of their disease. Few data on efficacy of 3rd and subsequent lines of chemotherapy are available. Although oral etoposide has been used for years in heavily pre-treated MBC patients, real-life data supporting its efficacy are lacking. Methods The primary objective was to assess progression free survival (PFS) in MBC patients having started oral etoposide as 3rd line chemotherapy or more, using the French Epidemiological Strategy and Medical Economics (ESME) database, established in 2014 by Unicancer. Secondary objectives were overall survival (OS) and descriptive and prognostic analyses. Results Of 16703 MBC patients included in the ESME program and covering the 2008-2014 period, 323 received at least 14 days of oral etoposide. Amongst them, 5 were men, 46 received etoposide as 1st or 2nd line chemotherapy, and 7 had no information available regarding line of treatment, leaving 265 for analysis. All received oral etoposide, 255 as monotherapy while 10 pts combined with trastuzumab for HER2+ MBC. Patients' and tumour characteristics are shown in table 1. The mean line of chemotherapy with oral etoposide was 5 (range 3-12). With a median follow-up of 32.2 months [CI95%: 22.0-42.1], median PFS and OS (from initiation of oral etoposide) were 3.1 months [95% CI 2.8-3.7] and 7.4 months [95% CI 6.0-9.9], respectively. No predictive factor for PFS could be identified (age at MBC diagnosis, BC subtype, number of metastatic sites, presence of visceral metastases, disease-free interval, line of treatment). Only a trend for longer PFS was seen in patients &amp;gt; 50 years old, with longer disease-free interval and receiving etoposide earlier. Triple-negative MBC had shorter OS compared to other subtypes (p=0.03). Of note, OS was stable around 7 months for subsequent lines following a 3rd line of chemotherapy. n%Age at MBC diagnosis&amp;lt; 50 yo8331.3≥ 50 yo18268.7Primary BC subtypeER+ HER2-16662.6HER2+3814.3Triple negative5621.1ND51.9Number of metastatic sites115458.1≥ 211141.9Visceral metastasisNo13249.8Yes13350.2Disease-free intervalde novo4015.16-24 months4115.524-60 months7427.9&amp;gt; 60 months11041.5Chemotherapy line36323.846524.554717.764316.3≥ 74717.7 Conclusions Oral etoposide may achieve significant disease control in heavily pre-treated MBC, with a 3.1-month median PFS and independently from prognostic factors. Moreover, etoposide has the major advantage of an oral drug administered at home with a low cost. A case-control study is ongoing. Citation Format: Lerebours F, Carton M, Bacrie J, Pierga J-Y, Rouzier R, Saghatchian M, Dalenc F, Mailliez A, Levy C, Firmin N, Debled M, Leheurteur M, Desmoulins I, Lefeuvre C, Goncalves A, Uwer L, Ferrero J-M, Eymard J-C, Petit T, Mouret-Reynier M-A, Piot I, Perrocheau G, Caillot C, Perol D. Oral etoposide (VP-16) in heavily pre-treated metastatic breast cancer: A multicenter national observational study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-06.

Abstract P1-17-09: Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period

Abstract Background: Leptomeningeal disease (LMD) is a pattern of central nervous system (CNS) metastasis that occurs in metastatic breast cancer (MBC) patients (pts). Some reports have revealed that it occurs more frequently in pts with estrogen receptor-positive (ER+), HER2-MBC than in pts with other subtypes. However, in such ER+HER2-MBC pts, LMD mainly occurs in the terminal stage of the disease; thus, the details of LMD have not been well described. Methods: We reviewed the medical records of ER+HER2-MBC pts who were treated from 2002 to present, with the aim of assessing the incidence, background and outcomes of LMD. Statistical analyses were performed using the chi-squared test, Kaplan-Meyer method, log-rank test and a multivariate COX regression analysis. Results: We identified a total of 369 ER+HER2-MBC pts, and 102 (27.6%) developed CNS metastasis. LMD developed in 32 (8.7%) pts, with the median time to LMD of 778 days (95% confidence interval [CI] 335-1221; range 0-3757 days) from the diagnosis of MBC. In most cases (28, 87.5%), LMD was accompanied by bone metastasis, and 24 pts (75.0%) showed metastasis to the skull. Thirteen pts (40.6%) had accompanying brain metastasis (BM) at the diagnosis of LMD. The majority of the pts had symptoms (25, 78.1%), and their accompanying extra-CNS lesions showed progression (23, 71.9%). Palliative radiotherapy (RT) was introduced in 27 pts (84.4%), with 4 pts (12.5%) receiving whole CNS RT. The intrathecal injection of methotrexate was introduced to one patient. The median overall survival (OS) from the diagnosis of LMD was 104 days (95% CI 38-170); however, when limited to pts without BM (N = 19), the median OS was 146 days (95%CI 79-213). All of the pts died, and the causes of death were as follows: CNS lesion progression, n=10 (31.3%); cachexia, n=9 (28.1%); respiratory failure, n=8 (25.0%); hepatic failure, n=4 (12.5%) and infection, n=1 (3.1%). There was no significant relationship between the time to LMD and OS after the diagnosis of LMD (Spearman's ρ=0.55, not significant). The multivariate analysis did not reveal any specific factors—such as the patient age, the presence of any symptom(s) at the diagnosis of LMD, the distribution of extra-CNS lesion(s) or the control of extra-CNS lesion(s)—that affected OS after the diagnosis of LMD. As a control, 70 ER+HER2-MBC pts who developed BM without LMD (BM-only group) within the same observation period were analyzed. The median time to BM was 611 days (95%CI 404-818), and it did not differ from that of pts with LMD (LMD-group) to a statistically significant extent (P &amp;gt;0.1). The BM-only group showed superior OS after the diagnosis of their CNS lesions in comparison to LMD-group (median, 295 days and 104 days, respectively, P &amp;lt;0.001). At the diagnosis of the CNS lesion, the LMD-group showed a higher rate of CNS symptoms (P &amp;lt;0.01), a lower rate of liver metastasis (P &amp;lt;0.05), a higher rate of bone metastasis (P &amp;lt;0.05) and a higher rate of skull metastasis (P &amp;lt; 0.01). Conclusion: Our retrospective analysis at a single institute revealed that the prognosis of LMD in pts with ER+HER2-MBC was still extremely poor. The data suggest that LMD is distinct from BM in terms of its pathology and response to therapy. Citation Format: Watanabe J, Mitsuya K, Hayashi N, Nakasu Y. Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-09.

Abstract P3-04-03: Identification, clinical characteristics and treatment outcomes of somatic human epidermal growth factor receptor 2 (ERBB2) mutations in metastatic breast cancer patients

Abstract Background The human epidermal growth factor receptor 2 (ERBB2) can be altered by somatic mutations (with/without ERRB2 amplification) that likely drive tumorigenesis. Here, we present the first study that thoroughly investigates the behavior of patients with ERBB2 mutated tumors in a large unselected cohort of metastatic breast cancer (MBC) patients. Patients and Methods We included retrospectively all MBC patients with sufficient tumor material available, independent of hormone receptor or ERBB2 amplification status, diagnosed between 2000 and 2015 at the Multidisciplinary Breast Center of University Hospitals Leuven. Genomic DNA extracted from primary breast tumors was subjected to deep targeted re-sequencing using an assay covering 5 exons (exons 8, 17, 19, 20 and 21) known to accumulate ERBB2 hotspot mutations. Clinical characteristics, treatment response and outcomes (excluding bilateral BC) were compared between patients with and without ERBB2 mutations. Results We established and validated a research use only next-generation sequencing assay across five exons of ERBB2. Somatic ERBB2 mutations with an allelic frequency of ≥5% in at least one independent analysis, were observed in 1.8% (13/721) of MBC patients. MBC patients with ERBB2 mutant primary tumors appear to have similar patient and tumor characteristics (TNM stage, grade, and receptor and HER2 status) compared to non-mutant patients and ERBB2 mutations occur in all molecular subtypes (7 ER+/HER2-, 4 HER2+, 2 triple negative). However, we see a small trend towards enrichment in the invasive lobular carcinomas (ILC) in the ERBB2 mutant patients vs. the non-mutant patients (4/13 (31%) vs. 97/695 (14%), p=0.086). ER+ patients with an ERBB2 mutant tumor who received first line aromatase inhibitor (AI) (n=3) had a worse median time to progression (TTP) compared to non-mutant patients (n=156) (TTP 103 vs. 311 days, p=0.04), AI use in any line had also a worse TTP (n=8 vs. 376; TTP 74 vs. 213 days, p=0.006). TTP was not significantly different for other standard therapies, but numbers were small. Median distant disease free survival (DDFS) defined as time from primary diagnosis to first metastasis, was slightly shorter for ERBB2 mutant tumors (n=9 vs 514; DDFS 1.4 vs. 2.9 years, p=0.066). However, in ER+/HER2- ERBB2 mutant tumors, median DDFS was significantly shorter in non-mutant patients (n=5 vs. 328; DDFS 0.8 vs. 4.0 years, p=0.02). Median overall survival (OS) after diagnosis of MBC was numerically lower for mutant patients in all subtypes vs. non-mutant patients (n=11 vs. 669; OS 1.1 vs. 2.3 years, p=0.457), and in ER+/HER2- disease (n=6 vs. 431; OS 1.0 vs. 2.9 years, p=0.07). Conclusion In our large MBC cohort, patients with ERBB2 mutant tumors appear to have similar tumor and patient characteristics as ERBB2 non-mutant tumors. ERBB2 mutations do not seem to occur more or less often in specific breast cancer subtypes except for a slight increase for ILC. In ER+/HER2- MBC, patients with ERBB2 mutant tumors appear to be adversely prognostic; having a shorter DDFS after early breast cancer treatment, and in metastatic disease, they respond worse on AI and have a trend for worse OS compared to non-mutant cases. Citation Format: Jongen L, Floris G, Lambrechts D, Laenen A, Neven P, Mann G, Cutler Jr. RE, Lalani AS, Wildiers H. Identification, clinical characteristics and treatment outcomes of somatic human epidermal growth factor receptor 2 (ERBB2) mutations in metastatic breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-03.

Abstract P1-17-10: Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study

Abstract Background The incidence of brain metastases among women with metastatic breast cancer (MBC) ranges from 10 to 30% depending of breast cancer (BC) subtype. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC and brain involvement. Methods LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival (OS) was defined as the time from the diagnosis of brain metastases and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private) among patients who developed brain metastases. Cox regression analysis was performed for identification of independent prognostic factors associated with survival after brain metastases diagnosis. Results Among the 690 MBC patients included in the LACOG-0312 study, 145 (21%) were diagnosed with brain metastases. Of them, 94 (71,75%) were covered by the Brazilian public health care and 37 (28,25%) had private coverage. Baseline characteristics such as age at MBC diagnosis, stage IV at diagnosis and tumor subtypes were similar between both groups. Median time to develop brain metastases after diagnosis of MBC was 14 months in the whole population with no differences between public and private patients (13 vs. 17 months p=0.172). Median OS from the date of brain metastases diagnosis was similar for both groups: 10.0 months in private and 9.0 months in public health insured patients (HR 0.92 – 95%CI 0.55-1.51; p=0.729). In a multivariable analysis including type of health care coverage, only the triple negative BC subtype was associated with a worse survival post brain metastases diagnosis. Conclusion Our study indicates that health care coverage is not associated with survival outcomes in patients with MBC and brain metastases. Potential differences in the access to optimal care such as radiotherapy, surgery and systemic treatments may not play a significant role in the survival of theses patients possibly due to small clinical benefit of the current treatment options for brain metastases in breast cancer. Citation Format: Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-10.

Abstract P1-17-05: Prognostic impact of initial treatment modality for brain metastasis in metastatic breast cancer

Abstract Background: The routine screening of brain metastasis (BM) is not recommended in patients with metastatic breast cancer (MBC) by guidelines. Due to survival improvement and increased use of magnetic resonance imaging (MRI) contribute the increasing of MBC BM incidence. The incidence of BM and survival from BM were various by molecular subtypes. The prognostic role of early detection of oligo BM and subsequent local treatment by subtypes is not clear. We aimed to compare BM free survival (BMFS) and BM overall survival (BMOS) by both treatment modalities and subtypes. Methods: In the Yonsei Breast Cancer MBC Database, we identified 1252 MBC patients who were diagnosed from 2006 to 2016. Data of 358 MBC patients (127 HR+/HER2-, 80 HR+/HER2+, 64 HR-/HER2+, 87 HR-/HER2-) with BM were available for the analysis. BMFS was defined as the time from the diagnosis of MBC to the diagnosis of BM. MBC patients with initial BM were excluded from analysis of BMFS. BMOS was defined as the time from the diagnosis of BM to any cause of death. Treatment modalities were analyzed as three categories; whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and neurosurgery. Results: Among the 1252 MBC patients, 47.7%, 14.7%, 13.1%, 17.6%, and 6.9% had HR+/HER2-, HR+/HER2+, HR-/HER2+, HR-/HER2-, and unknown subtypes, respectively. The incidence of initial BM were highest among patients with HR-/HER2- (14.5%) and were lowest with HR+/HER2- (5.2%) Incidence of initial metastasisInitial metastatic sitesHR+/HER2-, n(%)HR+/HER2+, n(%)HR-/HER2+, n(%)HR-/HER2-, n(%)Unknown, n(%)PBrain31 (5.2)16 (8.7)12 (7.3)32 (14.5)6 (6.9)&amp;lt;0.001Lung197 (33)72 (39.1)62 (37.8)99 (45)33 (37.9)0.036Liver137 (22.9)46 (25)52 (31.7)56 (25.5)16 (18.4)0.122Bone403 (67.5)109 (59.2)66 (40.2)90 (40.9)48 (55.2)&amp;lt;0.001Distant LN176 (29.5)74 (40.2)60 (36.6)93 (42.3)22 (25.3)0.011Pleura116 (19.4)19 (10.3)23 (14)40 (18.2)13 (14.9)0.045 . The median BMFS was 17.3 months (95% confidence interval (CI); 14.32-20.28) among the all patients with BM. The median BMFS was significantly shorter in the ER-/HER- subtypes (12 months, 95% CI; 20.73-31.67), and followed by ER-/HER2+ (14.8 months, 95% CI; 11.50-18.10), ER+/HER2+ (20.9 months, 95% CI; 16.88-24.92), and ER+/HER2- (26.2 months, 95% CI; 20.73-31.67). The median BMOS was significantly better in the SRS (16.8 months; 95% CI; 13.53-20.07) and surgery group (13.4 months, 95% CI; 7.19-19.61) compared with WBRT (6.9 months, 95% CI; 5.04-8.76) and no treatment (1.2 months, 95% CI; 0.32-2.08). Conclusions: Incidence of initial BM and BMFS were significantly different by subtypes. Patients who were treated with SRS or neurosurgery showed better survival compared to WBRT. This findings support to consideration of screening of BM in HER2+ or triple negative subtypes for the early detection of oligo BM. Citation Format: Kim GM, Cho YU, Kim SI, Park S, Park HS, Kim JY, Chun YJ, Sohn J. Prognostic impact of initial treatment modality for brain metastasis in metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-05.

Quality of life and care needs in women with estrogen positive metastatic breast cancer: a qualitative study

Background: In recent years, the prognosis of metastatic breast cancer (MBC) has improved with more effective therapies applicable to a wider range of patients. To many patients, a MBC diagnosis thus initiates a prolonged course of illness and treatment. This qualitative study aimed to explore the long-term health-related quality of life (HRQoL) and support needs in MBC patients of all ages in the Danish context.Material and methods: Eighteen MBC patients participated in five qualitative focus group interviews that were analyzed using content analysis and a constructivist approach.Results: The participants described how MBC severely reduced their physical and psychosocial functioning and required a constant adaptation of their quality of life (QoL) standards in relation to their changing life situation and disease progression. Overall, they felt medically well-treated but lacked a multidisciplinary approach to care including psychological support, in particular, but also manual physiotherapy, health care coordination and social counseling. The participants called for continuity of care with the same health care professionals as this facilitated communication and flexibility in planning treatment and controls. They requested a reduction of precious time spend on treatment to enable them to focus on their most meaningful relations and activities.Conclusion: With the MBC diagnosis, the focus of treatment switches from disease eradication to prolonging survival, alleviating symptoms and improving QoL. To patients, MBC marks a shift in expectations from quantity to quality of life and a perpetual adaptation of their QoL standards. To sustain patients’ HRQoL, it is important that along with improvements in life-prolonging treatment, comprehensive care also supports their main psycho-social needs. These patients needed support in maintaining normality and role functioning enabling them to focus on living, not merely surviving, through this prolonged disease phase.

Impact of body mass index on the clinical outcomes of patients with HER2-positive metastatic breast cancer

BackgroundOverweight and obesity are associated with an increased risk of developing many types of cancer, including breast cancer. Moreover, increased body mass index (BMI) seems to be associated with a worse prognosis in patients with HER2-positive early breast cancer. However, little is known about the impact of BMI on the clinical outcomes of HER2-positive metastatic breast cancer (MBC). MethodsThis was a multicenter retrospective cohort study including 329 consecutive patients with HER2-positive MBC treated with first-line trastuzumab-based regimens. BMI at the time of MBC diagnosis was collected. World Health Organization BMI categories were used: underweight <18.5, normal 18.5–24.9 Kg/m2, overweight 25–29.9 Kg/m2, and obese ≥30 Kg/m2. The analyses were conducted using two categories: BMI < 25.0 (normal/underweight) and BMI ≥ 25 (overweight/obese). Progression-free survival (PFS) and overall survival (OS) rates were estimated using Kaplan-Meier method. Univariate and multivariate survival analyses were performed using the Cox's proportional hazards model. Disease response to therapy was analyzed using univariate and multivariate logistic regression. ResultsOverall, 176 (53.5%) patients were normal/underweight and 153 (46.5%) overweight/obese. Median PFS was 14.8 months in BMI < 25 group and 15.7 months in BMI ≥ 25 group (adjusted-HR 0.88; 95% CI 0.66–1.17; p = 0.387). Median OS was 58.6 months in BMI < 25 group and 52.6 in BMI ≥ 25 group (adjusted-HR 0.88; 95% CI 0.59–1.31; p = 0.525). Overall response rate was 71.7% and 65.9% (p = 0.296) and clinical benefit rate was 82.1% and 83.3% (p = 0.781) in BMI < 25 and BMI ≥ 25 groups, respectively. ConclusionsBMI does not seem to be associated with clinical outcomes in HER2-positive MBC patients.

P1-013 - Eribulin efficacy for metastatic breast cancer amongst the real-world treatment pattern

Treatments options for metastatic breast cancer (MBC) have become more efficacious and numerous. Eribulin is an active agent for MBC treatment, but the effective usage of this drug is still unclear. Although the usage of eribulin for MBC in Europe is limited to patients who exposed to minimum of two previous chemotherapy regimens including anthracyclines and taxanes in the adjuvant or metastatic setting, there is no such strict limitation in Japan. The purpose of this retrospective study is to evaluate effective usage of erubulin in pretreated metastatic breast cancer patients in daily practice. Chart review was done for the patients who underwent chemotherapy, which include at least paclitaxel or eribulin for metastatic breast cancer between October 2012 and April 2016 in our single institute. One hundred and fifty patients were included in our cohort. The primary efficacy measure assessed overall survival (OS). Among human epidermal growth factor receptor 2 (HER2) negative patients, 51 received eribulin (eribulin group) and 66 received conventional chemotherapy excluding erubulin (non-eribulin group). The median OS from MBC diagnosis in the eribulin group was 39.0 months compared with 22.7 months in the non-eribulin group [hazard ratio (HR): 0.46, 95%CI 0.29-0.73; p = 0.001]. Eribulin seemed to have significant survival benefit in patients with lung metastasis, but not in patients without lung metastasis in our cohort. Same trend was recognized with liver metastasis, or bone metastasis. Eribulin therapy may have a survival benefit in Japanese women with HER2 negative MBC. And may have benefit in MBC patients with lung, liver or bone metastasis.

275P - First-line treatment patterns by age for patients (pts) with HER2+ metastatic breast cancer (MBC) in the SystHERs registry

Background: Clinical outcomes for pts with HER2+ MBC may differ by age, potentially influenced by differences in treatment regimens administered to older vs younger pts. Systematic Therapies for HER2+ Metastatic Breast Cancer Study (SystHERs) captures real-world treatment patterns and outcomes in pts with HER2+ MBC. Here, we examine baseline characteristics, first-line treatments, and breast cancer–specific survival (BCSS) by age. Methods: SystHERs is a fully enrolled (Jun 2012–Jun 2016), ongoing, US-based, observational study. Pts were ≥18 years old and had HER2+ MBC diagnosed within 6 months of enrollment. Pts were grouped by age at MBC diagnosis (<50, 50–69, or ≥ 70 years) and compared descriptively. BCSS was defined as time from the date of MBC diagnosis to date of death due to MBC progression. Results: As of Feb 10, 2017, of 978 eligible pts, 287 were <50 years old, 563 were 50–69, and 128 were ≥70 at MBC diagnosis. Median follow-up from MBC diagnosis was 23, 22, and 19 months, respectively. Baseline characteristics, first-line treatments, and BCSS are shown (Table). In pts who received chemotherapy, docetaxel was the most common agent in pts <50 (67%) and 50–69 (64%) followed by paclitaxel (29% in both groups), whereas in pts ≥70, 43% and 45% received docetaxel and paclitaxel, respectively.Table275P<50 years (n = 287)50-69 years (n = 563)≥70 years (n = 128)Baseline characteristicsMedian age at MBC diagnosis, years (range)43 (21–49)59 (50–69)75 (70–90)Eastern Cooperative Oncology Group performance score 0–1, n (%)249 (87)476 (85)101 (79)De novo, n (%)158 (55)278 (49)52 (41)Median time from early breast cancer diagnosis to MBC diagnosisaIn pts with recurrent MBC only. H, trastuzumab; P, pertuzumab., months (range)36 (9–166)50 (5–329)42 (4–452)Estrogen receptor positive and/or progesterone receptor positive, n (%)203 (71)387 (69)96 (75)Visceral disease, n (%)196 (68)378 (67)75 (59)≥3 metastatic sites, n (%)87 (30)183 (33)32 (25)Bone metastasis, n (%)165 (57)282 (50)57 (45)Liver metastasis, n (%)117 (41)216 (38)33 (26)First-line treatments, n (%) (Treatments are not mutually exclusive)Any HER2-targeted therapy PH H without P275 (96) 229 (80) 37 (13)531 (94) 414 (74) 93 (17)116 (91) 68 (53) 44 (34)Any chemotherapy PH + taxane H without P + taxane254 (89) 207 (72) 18 (6)489 (87) 386 (69) 53 (9)86 (67) 55 (43) 16 (13)Any hormonal therapy With PH With H without P113 (39) 91 (32) 18 (6)230 (41) 161 (29) 48 (9)67 (52) 30 (23) 28 (22)Breast cancer -specific survival, % (95% confidence interval)Breast cancer–specific survival rate 12 months 24 months 36 months95 (92–97) 86 (81–90) 78 (71–84)92 (89–94) 80 (76–84) 68 (63–73)92 (85–95) 80 (71–87) 64 (48–76)a In pts with recurrent MBC only. H, trastuzumab; P, pertuzumab. Open table in a new tab Conclusions: In this preliminary real-world analysis of pts with HER2+ MBC, pertuzumab (P) + trastuzumab (H) was more commonly used than H without P across all age groups. Pts <50 and 50–69 years old more commonly received PH + taxane than those ≥70 (72% and 69% vs 43%, respectively). Compared with younger pts, those ≥70 received regimens with chemotherapy less commonly (89% and 87% vs 67%), and more commonly received regimens with H without P (13% and 17% vs 34%) or hormonal therapy (39% and 41% vs 52%). Pts <50 had longer BCSS than those ≥70 (78% vs 64% at 3 years). Clinical trial identification: NCT01615068 Legal entity responsible for the study: Genentech/Roche Funding: Genentech/Roche Disclosure: M. Jahanzeb: Consulting fees from Roche. Data and Safety Monitoring Board for Puma. D. Tripathy: Consulting fees from Puma Biotech, NEKTAR Pharma, Novartis. Contracted research paid to institution from Novartis. S.A. Hurvitz: Research funding from Amgen, Bayer, Boehringer Ingleheim, Genentech, GSK, Pfizer, Roche, Biomarin, Merrimack, PUMA, Dignitana, Medication. Research and travel from Lilly, Novartis, OBI Pharma. J. O'Shaughnessy: Consulting fees from Genentech. G. Mason: Advisory Board: Avon Foundation for Women Scientific. D.A. Yardley: Fees for services from Novartis and Genentech. Contracted research paid to institution from Genentech and Novartis. A. Brufsky: Consulting fees from Roche. H.S. Rugo: Fees for services from Genomic Health. contracted research paid to institution from Genentech, Pfizer, Novartis, Lilly, OBI Pharma, GTX, Macrogenics, Merck. M. Cobleigh: Royalties and Receipt of IP rights from Genomic Health. Consulting fees from Genentech/Roche and GSK. Contracted research from Genentech/Roche, Merrimack, Macrogenics, NRG foundation. S.M. Swain: Consulting fees from Genentech/Roche, Novartis, and Pieris. Contracted research paid to institution from Genentech/Roche, Pfizer, Merrimack, and Lilly. L. Chu, V. Antao, B. Yoo: Employment at Genentech. Stock ownership in Roche. P.A. Kaufman: Consulting fees from Genentech. Contracted research paid to institution from Genentech/Roche.

Lobular Metastatic Breast Cancer Patients With Gastrointestinal Involvement: Features and Outcomes

IntroductionMetastatic breast cancer typically involves the lungs, bones, brain, and liver and only occasionally affects the gastrointestinal (GI) tract. The relevant published data have been limited to case reports and small series of patients. Patients and MethodsThe present study focused on the treatment and outcomes of breast cancer patients with GI involvement diagnosed at the European Institute of Oncology. We analyzed the clinicopathologic features of the GI metastases and compared them with those of the primary tumors according to their histologic type (ductal or lobular carcinoma). ResultsFrom the database of the Department of Pathology, 40 patients who had undergone endoscopy or GI surgery with a final diagnosis of metastatic breast cancer from 2000 to 2014 were identified. The greatest proportion of patients (75%) had had primary invasive lobular carcinoma. Of the 40 patients, 82% had hormone receptor-positive disease in the metastatic lesion; 34 patients were candidates for systemic therapy. The median length of observation after GI metastasis was 18 months (range, 0.6-79 months). The overall survival from the diagnosis of GI involvement was 33 months (95% confidence interval, 16.8-38.3 months). ConclusionLobular breast carcinoma has a greater propensity to metastasize to the GI tract compared with other breast cancer subtypes. In the presence of GI symptoms, even if nonspecific, the GI tract should be thoroughly studied. Systemic treatment, including hormonal therapy, should be considered.

Colonic metastasis from breast carcinoma: a case report

BackgroundColonic metastasis from breast carcinoma is very rare. Here, we report a case of colonic metastasis from breast carcinoma.Case presentationThe patient was a 51-year-old woman. She had upper abdominal pain, vomiting, and diarrhea, repeatedly. We performed abdominal contrast-enhanced computed tomography (CT) to investigate these symptoms. The CT scan revealed a tumor in the ascending colon with contrast enhancement and showed an expanded small intestine. For further investigation of this tumor, we performed whole positron emission tomography-computed tomography (PET-CT). The PET-CT scan revealed fluorodeoxyglucose uptake in the ascending colon, mesentery, left breast, and left axillary region. Analysis of biopsy samples obtained during colonoscopy revealed signet ring cell-like carcinoma. Moreover, biopsy of the breast tumor revealed invasive lobular carcinoma. Therefore, the preoperative diagnosis was colonic metastasis from breast carcinoma. Open ileocecal resection was performed. The final diagnosis was multiple metastatic breast carcinomas, and the TNM classification was T2N1M1 Stage IV.ConclusionsWe presented a rare case of colonic metastasis from breast carcinoma. PET-CT may be useful in the diagnosis of metastatic breast cancer. When analysis of biopsy samples obtained during colonoscopy reveals signet ring cell-like carcinoma, the possibility of breast cancer as the primary tumor should be considered.

Trastuzumab and survival of patients with metastatic breast cancer.

Prognosis of Her2-positive breast cancer has changed since the introduction of trastuzumab for treatment in metastatic and early breast cancer. It was described to be even better compared to prognosis of Her2-negative metastatic breast cancer. The purpose of this study was to evaluate the effect of trastuzumab in our cohort. Besides the effect of adjuvant pretreatment with trastuzumab on survival of patients with metastatic Her2-positive breast cancer was analyzed. All patients with primary breast cancer of the Regional Breast Cancer Center Dresden diagnosed during the years 2001-2013 were analyzed for treatment with or without trastuzumab in the adjuvant and in the metastatic treatment setting using Kaplan-Meier survival estimation and Cox regression. Age and tumor stage at time of first diagnosis of breast cancer as well as hormone receptor status, grading, time, and site of metastasis at first diagnosis of distant metastatic disease were analyzed. Of 4.481 female patients with primary breast cancer, 643 presented with metastatic disease. Her2-positive status was documented in 465 patients, including 116 patients with primary or secondary metastases. Median survival of patients with Her2-positive primary metastatic disease was 3.0years (95% CI 2.3-4.0). After adjustment for other factors, survival was better in patients with Her2-positive breast cancer with trastuzumab therapy compared to Her2-negative metastatic disease (HR 2.10; 95% CI 1.58-2.79). Analysis of influence of adjuvant therapy with and without trastuzumab by Kaplan-Meier showed a trend for better survival in not pretreated patients. Median survival was highest in hormone receptor-positive Her2-positive (triple-positive) primary metastatic breast cancer patients with 3.3years (95% CI 2.3-4.6). Prognosis of patients with Her2-positive metastatic breast cancer after trastuzumab treatment is more favorable than for Her2-negative breast cancer. The role of adjuvant chemotherapy with or without trastuzumab warrants further research. Survival is best in triple-positive metastatic breast cancer. This will effect counseling at the time of first diagnosis of metastatic breast cancer.

Real-world effectiveness of fulvestrant monotherapy as first hormonal therapy in metastatic breast cancer patients.

e12537 Background: Fulvestrant is a selective estrogen receptor degrader approved as monotherapy for postmenopausal women with estrogen-receptor-positive metastatic breast cancer (MBC) who progress following anti-estrogen therapy. The recent Phase 3 FALCON study for hormone therapy (HT) naïve women showed increased median progression-free survival (PFS) (16.6 months) in fulvestrant treated patients (pts) compared with anastrozole (13.8 months), but real-world data are lacking. This study examined the real-world effectiveness of fulvestrant monotherapy as first (L1) or second line (L2) treatment after MBC diagnosis. Methods: This was a retrospective medical record review from 10 US community oncology practices. Female pts initiated fulvestrant monotherapy as the first HT after MBC diagnosis, administered as L1 or as L2 treatment following L1 chemotherapy. Fulvestrant was initiated between 1/1/2011 and 12/31/2015. Pts were classified as HT naïve; and HT relapse status: early relapse (≤12 months of adjuvant HT completion), late relapse (&gt;12 months). Time to first chemotherapy (TTC), PFS, and overall survival (OS) were evaluated using Kaplan-Meier analyses. Results: The study included 121 pts: mean (SD) age 65.7 (11.4) years, 81.8% Caucasian, 94.2% postmenopausal/undocumented, and 92.0% HER2-/undocumented. Overall, 15.7% were de novo metastatic and 86.0% initiated fulvestrant in L1. At the start of fulvestrant, 40.5% had visceral metastasis. The study results (Table 1) suggest better outcomes (TTC, PFS, OS) in HT naïve and late relapse pts, than early relapse pts. Conclusions: First line fulvestrant in the real-world setting demonstrates comparable PFS benefit to clinical trial results and appeared successful in delaying chemotherapy initiation in HT naïve and late relapse pts. This finding supports the use of fulvestrant monotherapy as the first hormonal therapy in a metastatic setting. [Table: see text]

Metastatic Breast Cancer Collateral Damage (MBCCD) project: Addressing unique needs and identifying patients at highest risk.

e21592 Background: From The Health of Women (HOW) Study™, we found that participants living with metastatic breast cancer (MBC) had a considerably diminished quality of life (QoL) compared to those with less advanced breast cancer. When faced with MBC, managing and minimizing collateral damage (CD) resulting from sequential and often continuous treatments is crucial to improving QoL. The aim of the MBCCD Project was to characterize the unique experience of MBC in order to identify and address potential areas of need in this underserved population. Methods: We crowdsourced input and gathered free-text data from 353 MBC patients to document the breadth of CD affecting QoL. We then developed a new questionnaire using validated QoL scales and PROMIS measures, along with a novel assessment of Living with MBC derived from the crowdsourcing data, which, in some cases, included verbatim statements from patients. Results: Among the 515 MBC respondents, the median age was 57 years (28-86 years), and the majority was female (99%) and non-Hispanic White (91%). Patients retrospectively reported a significant decline in overall QoL after MBC diagnosis (Before MBC: 51% excellent and1% poor/extremely poor; After MBC diagnosis: 12% excellent and15% poor/extremely poor; p &lt; 0.05). As expected, considerable CD was reported in every aspect of the patients’ lives—physical, social, financial and psychological. MBC patients who were younger ( &lt; 50 years), had lower financial status, and/or reported having children under the age of 18 years living at home were identified as being at highest risk of significant CD in every category (p &lt; 0.05). Contrary to common belief in the clinical setting, CD did not vary as a function of treatment type or metastatic location. Conclusions: Findings illustrate the need for dynamic and personalized strategies targeting CD to improve the health and well-being of MBC patients. Within each area of CD, critical needs and subsets of patients at highest risk were identified. Next steps include increasing diversity and working with MBC advocates and provider-survivor collaborators to develop recommendations that maximize benefit to MBC patients while remaining feasible for providers.

Mammography use in breast cancer survivors: An administrative claims study.

6531 Background: Annual mammography is recommended to screen residual breast tissue for new cancers and recurrent disease after treatment for early stage breast cancer. This study aimed to assess mammography rates over time in breast cancer survivors. Methods: We used administrative claims data from a large U.S. commercial insurance database, OptumLabs, to retrospectively identify privately- and Medicare Advantage-insured women with operable breast cancer who had residual breast tissue after definitive breast surgery between 2006 and 2015. We required coverage for at least 13 months following surgery. For each subsequent 13-month time period, we only included women without a loss of coverage, bilateral mastectomy, metastatic breast cancer diagnosis, or non-breast cancer diagnosis. We calculated the proportion of patients who had a mammogram during each 13-month period following breast surgery. We used multivariable logistic regression to test for factors associated with mammography in the first 13 months. Results: The cohort included 26,011 women followed for a median of 2.9 years (IQR 1.9-4.6) after surgery; 63.1% were less than 65 years of age, and 74.4% were white. In their first year of follow-up, 86% underwent mammography, but by year 7, this decreased to 73%. Fewer than 1% underwent MRI instead of mammography. In multivariable analysis, mammograms were less likely during the first year after surgery among women aged &lt; 50 years (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6 to 0.8), African Americans (OR, 0.7; 95% CI, 0.7 to 0.8), patients who underwent mastectomy (OR, 0.7; 95% CI, 0.6 to 0.7), and patients residing in the Western part of the country (OR, 0.9; 95% CI, 0.7 to 0.9). Those with 1-2 comorbidities were more likely (OR, 1.1; 95% CI 1.1-1.2) than those with none to have a mammogram during that period. Mammography use did not differ significantly by year of diagnosis (2006-2015). Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance mammography. Mammography use falls as the time from the early stage breast cancer diagnosis increases. Understanding factors associated with lack of mammographic screening may help improve survivorship care.

Evolution of overall survival according to year of diagnosis (2008-2014) and subtypes, among 16703 metastatic breast cancer (MBC) patients included in the real-life "ESME" cohort.

1078 Background: Real-life data may help checking that public investments match closely medical needs. During the last decade, several drugs have been released on the market for MBC on the basis of a potential impact on overall survival (OS). Based on the large real-life ESME cohort, we aimed to describe the time evolution of MBC OS according to main phenotypes. Methods: ESME is a unique MBC national cohort including all consecutive patients (pts) who initiated treatment for MBC between 1/01/08 and 31/12/14 in the 18 French comprehensive cancer centres. ESME collects retrospective data using clinical trial-like methodology including quality assessments. Database lock was 8/12/2016. Primary objective was the impact of year of MBC diagnosis on OS. Multivariate Cox regressions were used with adjustment for main prognostic covariates. Results: 15170 out of 16703 pts in ESME had full IHC data allowing their classification as HR+HER2- (N=9922), HER2+ (N=2863), or HR-HER2- (N=2321) cases. Median FU and OS for the whole cohort are 4.05 yrs [95 CI: 3.98-4.12], and 3.1 yrs [95 CI: 3.03-3.18] respectively. In the adjusted multivariate analysis, year of MBC diagnosis, age at MBC, subtype (using HER2+ as reference), disease-free interval (DFI), visceral involvement, and number (nbr) of metastatic sites are significant OS predictors (table) although with low effect for the first item. Age at MBC, DFI, visceral involvement, and nbr of metastatic sites remained significant prognostic variables in subtypes. Year of diagnosis was no longer significant in HR+HER2- nor HR-HER2- cases (HR=0.997, p=0.71 and HR=0.997, p=0.84), while it was highly significant in HER2+ cases (HR=0.91, p&lt;0.0001). Conclusions: Although OS of MBC has slightly improved over the past decade, this remains mostly confined to HER2+ cases, highlighting the need for new strategies for the luminal and triple negative populations. [Table: see text]

The diagnostic value of serum tumor markers CEA, CA19-9, CA125, CA15-3, and TPS in metastatic breast cancer

This study aims to understand the diagnostic value of serum tumor markers carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), cancer antigen 15-3 (CA15-3), and tissue polypeptide-specific antigen (TPS) in metastatic breast cancer (MBC). A total of 164 metastatic breast cancer patients in Shanxi Cancer Hospital were recruited between February 2016 and July 2016. 200 breast cancer patients without metastasis in the same period were randomly selected as the control group. The general characteristics, immunohistochemical, and pathological results were investigated between the two groups, and tumor markers were determined. There were statistical differences in the concentration and the positive rates of CEA, CA19-9, CA125, CA15-3, and TPS between the MBC and control group (P<0.05). The highest sensitivity was in CEA and the highest specificity was in CA125 for the diagnosis of MBC when using a single tumor marker at 56.7% and 97.0%, respectively. In addition, two tumor markers were used for the diagnosis of MBC and the CEA and TPS combination had the highest diagnostic sensitivity with 78.7%, while the CA15-3 and CA125 combination had the highest specificity of 91.5%. Analysis of tumor markers of 164 MBC found that there were statistical differences in the positive rates of CEA and CA15-3 between bone metastases and other metastases (χ2=6.00, P=0.014; χ2=7.32, P=0.007, respectively). The sensitivity and specificity values of the CEA and CA15-3 combination in the diagnosis of bone metastases were 77.1% and 45.8%, respectively. The positive rate of TPS in the lung metastases group was lower than in other metastases (χ2=8.06, P=0.005).There were significant differences in the positive rates of CA15-3 and TPS between liver metastases and other metastases (χ2=15.42, P<0.001; χ2=9.72, P=0.002, respectively). The sensitivity and specificity of the CA15-3 and TPS combination in the diagnosis of liver metastases were 92.3% and 45.6%, respectively, and the positive rate of CEA in triple-negative metastatic breast cancer is lower than in other subtypes (χ2=4.80, P=0.028). Therefore, serum CEA, CA19-9, CA125, CA15-3, and TPS can be used in the diagnosis of MBC, and different combinations of tumor markers have varying diagnostic value.