Stage IV Research Articles

Regional variation in the management of metastatic gastric cancer in Ontario.

Geographic variation in cancer care is common when clear clinical management guidelines do not exist. In the present study, we sought to describe health care resource consumption by patients with metastatic gastric cancer (gc) and to investigate the possibility of regional variation. In this population-based cohort study of patients with stage iv gastric adenocarcinoma diagnosed between 1 April 2005 and 31 March 2008, chart review and administrative health care data were linked to study resource utilization outcomes (for example, clinical investigations, treatments) in the province of Ontario. The study took a health care system perspective with a 2-year time frame. Chi-square tests were used to compare proportions of resource utilization, and analysis of variance compared mean per-patient resource consumption between geographic regions. A cohort of 1433 patients received 4690 endoscopic investigations, 12,033 computed tomography exams, 12,774 radiography exams, and 5059 ultrasonography exams. Nearly all patients were seen by a general practitioner (98%) and a specialist (99%), and were hospitalized (95%) or visited the emergency department (87%). Fewer than half received chemotherapy (43%), gastrectomy (37%), or radiotherapy (28%). The mean number of clinical investigations, physician visits, hospitalizations, and instances of patient accessing the emergency department or receiving radiotherapy or stent placement varied significantly by region. Variations in health care resource utilization for metastatic gc patients are observed across the regions of Ontario. Whether those differences reflect differential access to resources, patient preference, or physician preference is not known. The observed variation might reflect a lack of guidelines based on high-quality evidence and could partly be ameliorated with regionalization of gc care to high-volume centres.

External validation of non-imaging models for predicting distant metastasis in patients with endometrial cancer

ObjectiveTo evaluate two non-imaging models designed to predict distant metastasis (stages IIIC–IV) in endometrial carcinoma (EC). Both used preoperative histological and biological findings. One used primary tumoral size, the other did not. Methods374 patients operated on for EC by hysterectomy and at least bilateral pelvic lymphadenectomy were included. Patient's characteristics, preoperative histological, biological findings and primary tumoral size were used to calculate for each patient two scores (one for each model) for distant metastasis. The accuracy of the models was evaluated in terms of areas under the receiver operating characteristic curves (AUCs), rates of false negatives, and number of patients in the group at low risk to predict stages IIIC–IV. Results309 and 65 patients had FIGO stages IA–IIIB and IIIC–IV respectively. Thrombocytosis and leukocytosis were not significantly different between patients who had distant metastasis and those who did not. CA125 serum level was significantly higher in patients who had distant metastasis (71.2 vs 32.0U/mL, p<0.001). High-risk preoperative histology and primary tumor diameter >3cm were more frequently observed in patients who had distant metastasis (55.4% and 39.9%, p=0.02 and 21.3% and 8.5%, p=0.003). The AUC were 0.65 [0.63–0.67] and 0.68 [0.63–0.67] with 54% and 93.4% sensitivity, 64% 19.1% specificity. Two hundred and twenty nine patients (61.2%) and 62 (17.0%) were classified as low risk; among them, 30 patients (13.2%) and 4 (6.4%) had final stage IIIC or IV. ConclusionBoth models turned out to have a low discrimination power in our population. However, the score using primary tumoral size permits to identify a subgroup of patients in whom metastatic probability is low and lymphadenectomy unnecessary. Preoperative CA125 level, histological findings and primary tumoral size remain prognostic factors of stages IIIC–IV and should be included in predictive models.

Prognostic factors for long term survival in patients with advanced non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) represents 85% of all lung cancers. It is estimated that 60% of patients with NSCLC at time of diagnosis have advanced disease. The aim of this study was to investigate clinical and demographic prognostic factors of long term survival in patients with unresectable NSCLC. We retrospectively reviewed data of 1,156 patients with NSCLC stage IIIB or IV who survived more than 60 days from the time of diagnosis and treated from August 1987 until March 2013 in the Oncology Department of Pulmonary Clinic of the General Hospital Papanikolaou. Initially univariate analysis using the log-rank test was conducted and then multivariate analysis using the proportional hazards model of Cox. Also Kaplan Meier curves were used to describe the distribution of survival times of patients. The level of significance was set at 0.05. The mean age at diagnosis was 62 years. About 11.9% of patients were women and 88.1% were male. The majority of cases were adenocarcinomas (42.2%), followed squamous (33%) and finally the large cell (6%). Unlike men, most common histological type among women was adenocarcinoma rather than squamous (63% vs. 10.9%). In univariate analysis statistically significant factors in the progression free survival (PFS) and overall survival (OS) were: weight loss ≥5%, histological type, line 1 drugs, line 1 combination, line 1 cycles and radio lung. Specifically radio lung gives clear survival benefit in the PFS and OS in stage IIIB (P=0.002) and IV (P<0.001). On the other hand, the number of distant metastases in stage IV patients did not affect OS, neither PFS. In addition patients who received platinum and taxane had better PFS (P=0.001) and OS (P<0.001) than those who received platinum without taxane. Also the third drug administration proved futile, since survival (682.06±34.9) (P=0.023) and PFS (434.93±26.93) (P=0.012) of patients who received less than three drugs was significantly larger. Finally, large cell carcinoma recorded the shortest OS and PFS compared with adenocarcinoma (P=0.043 and P=0.016 respectively) and squamous cell carcinoma (P=0.021 and P=0.004 respectively). In multivariate analysis the same predictors were statistically significant except for line 1 drugs. This study confirms the increased incidence of adenocarcinoma in women than in men and the aggressiveness of large cell carcinoma. It also underlines the vitality of factors such as weight loss, radio lung and doublet platinum-based. On the other hand, it excludes significant factors such as gender, age and smoking.

PSS2 - The Comparative Effectiveness Of Adding Clostridial Collagenase Ointment To Standard Of Care In Individuals With Stage Iv Pressure Ulcers

PSS2 - The Comparative Effectiveness Of Adding Clostridial Collagenase Ointment To Standard Of Care In Individuals With Stage Iv Pressure Ulcers

Survival outcomes following hepatectomy for stage iv colorectal liver metastases: A comparison of liver- versus colon-first approach

Survival outcomes following hepatectomy for stage iv colorectal liver metastases: A comparison of liver- versus colon-first approach

A first look at relative survival by stage for colorectal and lung cancers in Canada.

Monitoring and reporting on cancer survival provides a mechanism for understanding the effectiveness of Canada's cancer care system. Although 5-year relative survival for colorectal cancer and lung cancer has been previously reported, only recently has pan-Canadian relative survival by stage been analyzed using comprehensive registry data. This article presents a first look at 2-year relative survival by stage for colorectal and lung cancer across 9 provinces. As expected, 2-year age-standardized relative survival ratios (arsrs) for colorectal cancer and lung cancer were higher when the cancer was diagnosed at an earlier stage. The arsrs for stage i colorectal cancer ranged from 92.2% in Nova Scotia [95% confidence interval (ci): 88.6% to 95.1%] to 98.4% in British Columbia (95% ci: 96.2% to 99.3%); for stage iv, they ranged from 24.3% in Prince Edward Island (95% ci: 15.2% to 34.4%) to 38.8% in New Brunswick (95% ci: 33.3% to 44.2%). The arsrs for stage i lung cancer ranged from 66.5% in Prince Edward Island (95% ci: 54.5% to 76.5%) to 84.8% in Ontario (95% ci: 83.5% to 86.0%). By contrast, arsrs for stage iv lung cancer ranged from 7.6% in Manitoba (95% ci: 5.8% to 9.7%) to 13.2% in British Columbia (95% ci: 11.8% to 14.6%). The available stage data are too recent to allow for meaningful comparisons between provinces, but over time, analyzing relative survival by stage can provide further insight into the known differences in 5-year relative survival. As the data mature, they will enable an assessment of the extent to which interprovincial differences in relative survival are influenced by differences in stage distribution or treatment effectiveness (or both), permitting targeted measures to improve population health outcomes to be implemented.

Hepatic resection may improve survival in patients with synchronic colorectal liver metastases operated on for obstructed stage iv colorectal cancer

Hepatic resection may improve survival in patients with synchronic colorectal liver metastases operated on for obstructed stage iv colorectal cancer

Comparison Of Overall Costs Between Alprostadil And Limb Amputation In Patients Affected By Peripheral Arterial Disease Stages Iii And Iv In Mexico

Comparison Of Overall Costs Between Alprostadil And Limb Amputation In Patients Affected By Peripheral Arterial Disease Stages Iii And Iv In Mexico

Percutaneous CT-guided microwave ablation as maintenance after first-line treatment for patients with advanced NSCLC.

BackgroundSystemic therapy is recommended for advanced non-small-cell lung cancer (NSCLC). However, conventional first-line treatment has generated a plateau in response rate of 25% to 35%. Few studies have shown patients benefit from microwave ablation (MWA) in combination with radiotherapy and chemotherapy. This study aims to evaluate safety and efficacy of percutaneous computed tomography-guided MWA as maintenance after first-line treatment for patients with advanced NSCLC.MethodsPatients with histologically verified NSCLC stage IIIB or IV between January 2010 and March 2014 were involved. After completion of first-line treatment with partial response or stable disease, 35 patients with 39 tumors underwent 39 MWA procedures. Complications, progression-free survival (PFS), overall survival (OS), and correlated predictors were analyzed.ResultsDuring a median follow-up of 17.7 months and 10.8 months after initial MWA, local efficacy was 87.2%, median MWA-related local control time was 10.6 months, and tumor size was the only predictor (P=0.002). Median MWA-related PFS, MWA-related OS, PFS, and OS were 5.4, 10.6, 11.8 and 17.7 months, respectively. Local efficacy was significantly correlated with MWA-related PFS (P=0.003), MWA-related OS (P=0.000), and OS (P=0.001). There were no procedure-specific deaths. Total incidence of major complications was 12.8%, including pneumothorax resolved by closed pleural drainage and pneumonia controlled by antibiotics in a short time.ConclusionThis study concluded two points, including: 1) patients benefited from MWA as maintenance both in local control and survival; 2) as maintenance MWA was superior to conventional maintenance therapy with improved survival and well-tolerated complications. Therefore, MWA was a safe and effective maintenance after first-line treatment in patients with advanced NSCLC.

Cumulative meta-analysis of epidermal growth factor receptor-tyrosine kinase inhibitors as first-line therapy in metastatic non-small-cell lung cancer.

We carried out a meta-analysis to evaluate the benefit of epidermal growth factor-tyrosine kinase inhibitors (EGFR-TKI) over the standard first-line platinum-based chemotherapy for metastatic non-small-cell lung cancer (NSCLC). Studies that were considered eligible included controlled prospective randomized phase III studies in patients with NSCLC stages IIIB or IV. These patients received standard first-line platinum-based chemotherapy or EGFR-TKI; overall survival and progression-free survival (PFS) with adequate data were available to calculate and estimate the hazard ratio (HR) with a confidence interval (CI) of 95%. Eight studies were identified that compared EGFR-TKI versus standard first-line platinum-based chemotherapy to treat NSCLC in 2962 patients. Patients receiving EGFR-TKI showed significantly longer PFS [HR=0.266 (95% CI=0.20-0.35), P<0.0001]. No significant difference in overall survival [HR=0.946 (95% CI=0.35-2.53), P=0.912] was observed between the groups. The cumulative meta-analysis of the studies showed that, since 2011 (OPTIMAL study), the PFS benefit in the EGFR-TKI arm was statistically significantly longer. Toxicity values greater than or equal to 3 in the most prevalent EGFR-TKI group included skin rash, diarrhea, and increased aminotransferase. EGFR-TKI treatment significantly extends PFS, with acceptable toxicities than platinum-based chemotherapy. Thus, they should be considered as the first choice in the first-line treatment for patients with NSCLC and with the EGFR mutation.

Diagnosing lung cancer in the 21st century: are we ready to meet the challenge of individualized care?

Histologic and molecular subtyping have become increasingly important as predictors of treatment benefit in lung cancer. The objective of the present study was to determine whether current diagnostic approaches provide adequate tissue to allow for individualized treatment decisions. Our retrospective cohort study of new lung cancer patients seen at an academic centre between July 2007 and June 2008 collected baseline demographic and diagnostic information, including mode of diagnosis, type of diagnostic material, and pathology diagnosis. Of the 431 study patients, 20% had stage i or ii non-small-cell lung cancer (nsclc), 24% stage iii disease, and 39% stage iv nsclc. Three quarters of the small-cell lung cancer (sclc) cases were extensive stage. Diagnostically, 18% of patients had sclc; 30%, adenocarcinoma; 27%, squamous-cell cancer; 2%, large-cell carcinoma; 1%, bronchoalveolar carcinoma; 1%, mixed histology; 18%, nsclc not otherwise specified; 4%, other; and 2%, no pathology diagnosis. Surgical pathology material was available in 80% of cases, and cytology material alone in 20%. Surgical pathology material was more common in patients with early-stage than with advanced disease (89% for stages i and ii vs. 74% for stages iii and iv, p < 0.0001). The pathology report included ambiguous terms in 24% of cases: "consistent" (12%), "suspicious" (3%), "favour" (2%), "suggestive" (2%), "likely" (1%), "compatible" with malignancy (1%), "at least" (1%), "atypical" (0.5%), and "no pathology" (1.5%). Current diagnostic approaches in most lung cancer patients appear adequate, but complete histopathologic identification is missing in nearly 20% of cases, and some uncertainty as to the final diagnosis is expressed in 24% of pathology reports. Some improvement in diagnostic sampling and pathology reporting are required to allow for implementation of current treatment approaches.

PTH-106 Survival outcomes following hepatectomy for stage iv colorectal liver metastases: a comparison of liver- versus colon-first approach

Introduction Liver-first approach compared to colon-first staged approach has been advocated for stage IV colorectal liver metastases (CRLM), but there is limited survival data to compare between these strategies. Our aim was to compare long term survival outcomes for liver- versus colon-first approach for stage IV CRLM. Method Between 2008 and 2013, patients with completed liver and colon resections for stage IV CRLM were included in this study. Patients with extrahepatic disease, synchronous resections and emergency colectomies were excluded. Patients in liver- (A) and colon- (B) first were stratified and compared using the Fong’s Clinical Risk Score (CRS). Results N=172 patients presented with stage IV colorectal cancer during the study period. N=25 had extrahepatic metastases, and were excluded. A further n = 88 patients, who underwent liver or colon resection were excluded as a result of disease progression (n = 11 liver n = 77 colon). N=59 (40%) had completed both liver and colonic resections, and comprised the study group (Group A: N=31; Group B: N=29). All patients had undergone neoadjuvant chemotherapy prior to resection. There was no difference in terms of age (p = 0.213), gender (p = 0.424), number (p = 0.839) and size (p = 0.725) of liver lesions in both groups. Fong’s CRS (1–5) was not significantly different for both treatment groups (p = 0.450). There was no difference in the overall survival (OS) (p = 0.846) and disease-free survival (DFS) (p = 0.675) between Group A and Group B. One-, 3- and 5-year OS for Group A versus Group B were 94% vs. 97%, 75% vs. 76% and 46% vs. 54%; and the DFS was 76% vs. 78%, 41% vs. 28% and 41% vs. 22% respectively. Conclusion The overall survival for liver-first approach is comparable to classic staged approach for stage IV colorectal cancer. Although not statistically significant, liver-first approach appears to provide a better disease-free survival at 3- and 5-years. Disclosure of interest None Declared.

Surgical Treatment of the Primary Tumor in Stage iv Breast Cancer

IntroductionThe aim of the study was to analyse the impact of locoregional surgery on survival of patients with stage IV breast cancer. Patients and methodsRetrospective study that included patients with breast cancer and synchronous metastases. Patients with ECOG above 2 and high-risk patients were excluded. The following variables were evaluated: age, tumour size, nodal involvement, histological type, histological grade, hormone receptor status, HER2 overexpression, number of affected organs, location of metastases, and surgical treatment. The impact of surgery and several clinical and pathologic variables on survival was analysed by Cox regression model. ResultsA total of 69 patients, of whom 36 (52.2%) underwent surgery (study group) were included. After a mean follow-up of 34 months, the median survival of the series was 55 months and no significant differences between the study group and the group of patients without surgery (P=.187) were found. Two factors associated with worse survival were identified: the number of organs with metastases (HR=1.69, CI 95%: 1.05–2.71) and triple negative breast cancer (HR=3.49, CI 95%: 1.39–8.74). Locoregional surgery, however, was not associated with survival. ConclusionsLocoregional surgical treatment was not associated with improved survival in patients with stage IV breast cancer. The number of organs with metastases and tumours were triple negative prognostic factors for survival.

PHS37 - Racial variation in the Clinical and Economic burden of Skeletal-related events among elderly Men with stage iv metastatic Prostate Cancer

Prostate cancer (PCa) outcomes vary widely among African American (AA) and non-Hispanic White (NHW) men. The authors investigated racial variation in the incidence of skeletal-related events (SREs) and SRE-related healthcare costs among AA and NHW men, a topic that has received limited attention in the literature. AA and NHW men diagnosed with metastatic PCa were identified from the linked Surveillance, Epidemiology and End Results–Medicare dataset. The sample included 6455 men with metastatic PCa, including 5420 NHW men and 1035 AA men. Approximately 16% experienced SREs during follow-up. AA men were less likely to experience SREs compared with NHW men, controlling for individual characteristics (adjusted odds ratio: 0.79; 95% CI: 0.66– 0.94). The SRE-specific costs were US$35,725 (US$22,190–US$49,260) among AA men and US$25,896 (US$21,669–US$30,123) among NHW men. Although AA men were less likely to experience SREs, there were substantial costs attributable to the treatment of SREs among AA men.

Comparison of single-agent chemotherapy and targeted therapy to first-line treatment in patients aged 80 years and older with advanced non-small-cell lung cancer.

PurposeThe aim of this study was to compare single-agent chemotherapy with targeted therapy in initial treatment and to explore a better choice of treatment for patients aged 80 years and older with advanced non-small-cell lung cancer (NSCLC).Patients and methodsA retrospective chart review was conducted for 136 patients aged 80 years and older who were cytopathologically diagnosed and staged as advanced (stage IIIB or IV) NSCLC. The patient population was divided into two treatment groups: 78 patients were allocated to the chemotherapy group (group A, pemetrexed or gemcitabine or docetaxel as a single agent), and 60 patients were allocated to another group and received epidermal growth factor-receptor tyrosine-kinase inhibitors (group B, erlotinib or gefitinib as a single agent). The primary end points were overall survival (OS) and progression-free survival (PFS), and the secondary end points were response rate, disease-control rate, safety, and quality of life.ResultsIn group A and group B, respectively, the median PFS was 2 versus 4 months (P=0.013), and the median OS was 8 versus 16 months (P=0.025). The 1- and 2-year survival rates of the two groups were 23.7% (group A, 18 of 76) versus 76.7% (group B, 46 of 60) and 13.2% (group A, ten of 76) versus 10% (group B, six of 60), respectively. The response rate and disease-control rate were 28.9% versus 36.7% (P=0.39) and 57.9% versus 76.7% (P=0.022) in group A and group B, respectively.ConclusionElders aged 80 years and over with advanced NSCLC in group B had longer PFS and OS compared with group A. It was well tolerated in group B because of the mild adverse effects. Targeted therapy can be considered primarily for patients aged 80 years and older with advanced NSCLC who cannot tolerate chemotherapy or radiotherapy.

112P - Efficacy and Safety of Imprime Pgg, a Novel Innate Immune Modulator, in Combination with Bevacizumab (BEV), Carboplatin and Paclitaxel for the 1St-Line Treatment of Stage Iv Nsclc

112P - Efficacy and Safety of Imprime Pgg, a Novel Innate Immune Modulator, in Combination with Bevacizumab (BEV), Carboplatin and Paclitaxel for the 1St-Line Treatment of Stage Iv Nsclc

103PD - Subgroup Analysis of Elderly Patients in Squire: a Randomized, Multicenter, Open-Label, Phase Iii Study of Necitumumab (N) Plus Gemcitabine-Cisplatin (GC) Chemotherapy Versus Gc Alone in First-Line Treatment of Patients (PTS) with Stage Iv Squamous Non-Small Cell Lung Cancer (SQ-NSCLC)

103PD - Subgroup Analysis of Elderly Patients in Squire: a Randomized, Multicenter, Open-Label, Phase Iii Study of Necitumumab (N) Plus Gemcitabine-Cisplatin (GC) Chemotherapy Versus Gc Alone in First-Line Treatment of Patients (PTS) with Stage Iv Squamous Non-Small Cell Lung Cancer (SQ-NSCLC)

Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review.

Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct. We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009-2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery. Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease. To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

Evaluation of Antitumor Activity Using Change in Tumor Size of the Survivin Antisense Oligonucleotide LY2181308 in Combination with Docetaxel for Second-Line Treatment of Patients with Non–Small-Cell Lung Cancer: A Randomized Open-Label Phase II Study

Chemoresistance is mediated, in part, by the inhibition of apoptosis in tumor cells. Survivin is an antiapoptotic protein that blocks chemotherapy-induced apoptosis. To investigate whether blocking survivin expression enhances docetaxel-induced apoptosis in patients with non-small-cell lung cancer (NSCLC), we compared the antitumor activity of the survivin inhibitor LY2181308 plus docetaxel with docetaxel alone. We used change in tumor size (CTS) as a primary endpoint to assess its use in early decision-making for this and future studies of novel agents in NSCLC. Patients (N = 162) eligible for second-line NSCLC treatment (stage IIIB/IV) with an Eastern Cooperative Oncology Group performance status of 0 to 1 were randomized 2:1 to receive LY2181308 (750 mg intravenously, weekly) and docetaxel (75 mg/m intravenously, day 1) or docetaxel alone every 21 days. CTS from baseline to the end of cycle 2 was compared between the two treatment arms. The mean (SD) tumor size ratio for LY2181308/docetaxel and docetaxel was 1.05 (0.21) and 1.00 (0.15) (p = 0.200), respectively, suggesting no significant improvement in antitumor activity between the arms. Because there was also no significant difference between the two arms for progression-free survival (PFS) (2.83 months with LY2181308/docetaxel and 3.35 months with docetaxel [p = 0.191]), both arms were combined. Using the combined arms, CTS correlated with PFS (PFS = 4.63 months in patients with decreased CTS compared with 2.66 months in patients with increased CTS), supporting its use in early decision-making in phase II studies.

P1-7-6 - Clinical Outcome of Endocrine Therapy for Hr + /Her2- Stage Iv Breast Cancer Patients

Background: Hormone receptor positive, HER2 negative (HR + /HER2-) is the most popular subtype in breast cancer. For HR + /HER2- stageIV patients, endocrine therapy is the first recommended regimen if it is not life-threatening disease, however there are few reports which demonstrated the predictive factors in this setting. The aim of this study is to evaluate the clinical outcome in HR + / HER2- stage IV breast cancer patients who received endocrine therapy for the first-line treatment to find the predictive factors for good response.Methods: Retrospectively, we reviewed HR + /HER2- stage IV breast cancer patients who started for the first-line regimen with endocrine therapy between 2005 and 2010.Results: Fifty-five patients were diagnosed with stageIV breast cancer in the period. Seven patients with bilateral breast cancer and eight patients who underwent no systemic therapy due to their severe condition, fifteen patients with other subtypes (HR- and/or HER2+) and seven HR + /HER2- patients started with chemotherapy were excluded from analysis, so finally 18 patents were reviewed in this study. The median age was 62.5 years and pre- and post- menopausal distribution was four and fourteen, respectively.Bone and/or lymph node metastasis only was found in 9 cases, and the other 9 cases found visceral metastasis.The patients who achieved longer first-line endocrine treatment duration tended to have longer duration with second- and third-line with hormonal drug and estrogen receptor highly positive (90%<) in the primary site was the only factor which predict who have good outcome with hormonal drug in this setting.Conclusions: As to the hormone treatment for HR + /HER2- stageIV breast cancer patients who have no visceral crisis, the patients with highly ER expressive tumor will be expected to treat effectively with endocrine therapy, but the patients with moderate to poorly ER expressive tumor might need to have another strategy rather than endocrine treatment alone.