Clinical outcomes among HR+/HER2− metastatic breast cancer patients with multiple metastatic sites: a chart review study in the US

Abstract

BackgroundHormone receptor-positive, human epidermal growth factor receptor-2-negative (HR+/HER2−) is the most common type of metastatic breast cancer (mBC). While mBC patients generally have poor prognosis with limited progression-free survival (PFS) and overall survival (OS), those with multiple metastatic sites may have even worse clinical outcomes due to multiple organ involvement. This study aimed to compare clinical outcomes including PFS, time on treatment (TOT), and OS between HR+/HER2− mBC patients with multiple metastases versus those with a single metastasis in a real-world clinical setting.MethodsThis was a retrospective chart review study of postmenopausal HR+/HER2− mBC women who had failed a non-steroidal aromatase inhibitor in the adjuvant or metastatic setting and initiated a new treatment for mBC between 07/01/2012 and 04/15/2013. Patients were classified to one of two study groups (multiple metastases or single metastasis) based on the number of non-lymph-node metastases at the initiation of the new treatment. PFS, TOT and OS were compared between the two groups using Kaplan–Meier analyses and multivariable Cox proportional hazard models adjusting for patient disease and treatment characteristics. Separate Cox models were conducted including models with an interaction term between line of therapy and study group to assess the impact of multiple metastases on clinical outcomes across different lines of therapy.ResultsA total of 699 patient charts were collected, including 291 patients with multiple metastases and 408 single metastasis patients. Worse performance status and a higher proportion of prior chemotherapy for mBC were observed among patients with multiple metastases. Overall, patients with multiple metastases had significantly shorter PFS [adjusted hazard ratio (HR) = 1.55, 95 % confidence interval (CI) 1.21–1.98], TOT (adjusted HR = 1.33, 95 % CI 1.05–1.67), and OS (adjusted HR = 1.77, 95 % CI 1.15–2.74) than single metastasis patients. Similar outcomes were observed in each line of therapy.ConclusionsAmong HR+/HER2− mBC patients, patients with multiple metastases had significantly shorter PFS, TOT, and OS than single metastasis patients, highlighting the substantial clinical burden and unmet need for more efficacious treatments for the former group of patients.

Survival Analysing of the Breast Cancer Patients Using Cure Model

“…In recent years, approximately 1.7 million new cases were diagnosed annually and 0.5 million deaths (per year) were caused by BC worldwide (3,4). In the US, BC caused approximately 231 000 newly diagnosed cases and about 40 000 deaths (17.3%) in 2015 (5,6). In Iran, BC is the most frequent cancer among malignancies in females and it caused 24.4% of all neoplasms with an incidence rate of 17.81 in 2006 (6).…”

New insights into patterns of first metastatic sites influencing survival of patients with hormone receptor-positive, HER2-negative breast cancer: a multicenter study of 271 patients

“…Several concepts regarding the prognosis of HR+/HER2-metastatic patients have been considered important in evaluating survival after recurrence [11], and the current study was performed based on post-recurrent characteristics, especially the metastatic site. Previous studies have shown that first metastatic sites (single, multiple, liver, or other visceral metastases) are significantly related to survival after recurrence in HR+/HER2-patients [10][11][12][13], but there has been clinical diversity in the metastatic distribution patterns of both single metastasis and multiple metastases [25][26][27]. Therefore, we studied the prognosis of HR+/HER2-patients with single and multiple metastases separately.…”

“…However, the metastatic patterns of first metastatic sites, such as multiple metastases, immediately life-threatening disease, or rapidly progressive visceral metastasis or crisis, have not been clearly evaluated. Although previous real-world studies have demonstrated several significant prognostic factors of survival after recurrence [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], little regard has been given to the influence of the metastatic distribution patterns of first metastatic sites on patients' prognosis. We assumed that the metastatic distribution patterns should be analyzed in more detail for the relationship with survival after recurrence in HR+/HER2-patients.…”

Outcomes research examining treatments, quality of life and costs in HER2 -negative and triple-negative metastatic breast cancer: a systematic literature review

“…Ten of these were retrospective chart reviews [29,30,[32][33][34]37,38,41,44,45], two were physician surveys [31,46] and six were analyses of secondary databases (e.g., Surveillance, Epidemiology and End Results [SEER]-Medicare database, commercial claims) [35,36,39,40,42,43]. These studies examined a variety of therapeutic options, including endocrine therapy, chemotherapy and surgery.…”

“…The authors concluded that cisplatin-gemcitabine combination chemotherapy is an effective regimen for patients with mTNBC. Xie et al [37] conducted a retrospective chart review study to compare clinical outcomes, PFS, TOT and OS between 699 HR-positive/HER2-negative mBC patients with multiple metastases versus those with a single metastasis. The authors concluded that patients with multiple metastases had significantly shorter PFS, TOT and OS than single metastasis patients, with similar outcomes in each line of therapy, highlighting the substantial clinical burden and unmet need for more efficacious treatments for the former group of patients.…”