Olivia Le Saux1, Audrey Lardy-Cleaud2, Sophie Frank3, Marc Debled4, Paul H Cottu3, Barbara Pistilli5, Laurence Vanlemmens6, Marianne Leheurteur7, Christelle Lévy8, Lilian Laborde9, Lionel Uwer10, Veronique D'hondt11, Delphine Berchery12, Veronique Lorgis13, Jean-Marc Ferrero14, Genevieve Perrocheau15, Coralie Courtinard16, Marie Ange Mouret-Reynier17, Michel Velten18, Mathias Breton19, Damien Parent20, Sylvie Chabaud2, Mathieu Robain16, Thomas Bachelot2. 1. Department of Medical Oncology, Léon Bérard Centre, Lyon, France. Electronic address: olivia.lesaux@gmail.com. 2. Department of Medical Oncology, Léon Bérard Centre, Lyon, France. 3. Department of Medical Oncology, Curie Institute, Paris, France. 4. Department of Medical Oncology, Bergonié Institute, Bordeaux, France. 5. Breast Cancer Unit, Gustave Roussy Institute, Villejuif, France. 6. Breast Unit, Oscar Lambret Centre, Lille, France. 7. Department of Oncology, Henri Becquerel Centre, Rouen, France. 8. Cancers & Preventions, François Baclesse Centre, Caen, France. 9. Data Management and Analysis Center, Paoli-Calmettes Institute, Marseille, France. 10. Department of Medical Oncology, Alexis-Vautrin Cancer Institute of Lorraine, Vandœuvre-lès-Nancy, France. 11. Department of Medical Oncology, Montpellier Regional Cancer Institute, Montpellier, France. 12. Department of Medical Information, Claudius Regaud Institute, Toulouse, France. 13. Department of Medical Oncology, Georges-François-Leclerc Centre, Dijon, France. 14. Department of Medical Oncology, Antoine Lacassagne Cancer Center, Nice, France. 15. Clinical Investigation Centre, René Gauducheau Centre, Saint-Herblain, France. 16. Department of Research and Development, R&D Unicancer, Paris, France. 17. Department of Medical Oncology, Centre Jean Perrin, Clermont Ferrand, France. 18. Department of Epidemiology and Biostatistics, Centre Paul Strauss, Strasbourg, France. 19. Medical Information Department, Centre Eugéne Marquis, Rennes, France. 20. Department of Pharmacy, Institut de Cancérologie Jean-Godinot, Reims, France.
Abstract
BACKGROUND: For luminal metastatic breast cancer (MBC), endocrine therapy (ET) is the recommended initial treatment before chemotherapy. Our objective was to evaluate the efficacy of multiple ET lines in a real-life study. METHODS: The Breast Cancer Epidemiological Strategy and Medical Economics (ESME) project analysed data from all patients with systemic treatment for MBC initiated between 2008 and 2014 in one of the 18 French Comprehensive Cancer Centres. The primary end-point was the successive progression-free survival (PFS) evaluation. RESULTS: The ESME research programme included 9921 patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2) negative (HER2-) MBC. Before any chemotherapy, 4195 (43.4%), 1252 (29.8%) and 279 (6.6%) patients received one, two or three ET ± targeted therapy, respectively. The median PFS for first-, second- and third-line ET ± targeted therapy was 11.5 (95% confidence interval [CI], 10.8-12.1), 5.8 (95% CI, 5.3-6.1) and 5.5 (95% CI, 4.6-6.3) months, respectively. In a multivariate analysis, time from diagnosis to metastatic recurrence (P < 0.0001), presence of symptoms at metastatic relapse (P = 0.01), number of metastatic sites (P = 0.0003) and their localisation (P < 0.0001) were prognostic factors for PFS1. Duration of previous PFS was the only prognostic factor for subsequent PFS (10% threshold). Ten percent of the patients showed long-term response to ET, with a total treatment duration before chemotherapy ≥43.6 months. CONCLUSIONS: Median PFS in our HR+/HER2- real-life cohort is similar to median first-line PFS reported in clinical trials, regardless of ET used as second- and third-line treatment. Despite the international consensus on early initiation of ET, the latter is not prescribed in most of the cases. Patients with a low tumour burden may achieve prolonged response on ET.
BACKGROUND: For luminal metastatic breast cancer (MBC), endocrine therapy (ET) is the recommended initial treatment before chemotherapy. Our objective was to evaluate the efficacy of multiple ET lines in a real-life study. METHODS: The Breast Cancer Epidemiological Strategy and Medical Economics (ESME) project analysed data from all patients with systemic treatment for MBC initiated between 2008 and 2014 in one of the 18 French Comprehensive Cancer Centres. The primary end-point was the successive progression-free survival (PFS) evaluation. RESULTS: The ESME research programme included 9921 patients with hormone receptor-positive (HR+)/humanepidermal growth factor receptor 2 (HER2) negative (HER2-) MBC. Before any chemotherapy, 4195 (43.4%), 1252 (29.8%) and 279 (6.6%) patients received one, two or three ET ± targeted therapy, respectively. The median PFS for first-, second- and third-line ET ± targeted therapy was 11.5 (95% confidence interval [CI], 10.8-12.1), 5.8 (95% CI, 5.3-6.1) and 5.5 (95% CI, 4.6-6.3) months, respectively. In a multivariate analysis, time from diagnosis to metastatic recurrence (P < 0.0001), presence of symptoms at metastatic relapse (P = 0.01), number of metastatic sites (P = 0.0003) and their localisation (P < 0.0001) were prognostic factors for PFS1. Duration of previous PFS was the only prognostic factor for subsequent PFS (10% threshold). Ten percent of the patients showed long-term response to ET, with a total treatment duration before chemotherapy ≥43.6 months. CONCLUSIONS: Median PFS in our HR+/HER2- real-life cohort is similar to median first-line PFS reported in clinical trials, regardless of ET used as second- and third-line treatment. Despite the international consensus on early initiation of ET, the latter is not prescribed in most of the cases. Patients with a low tumour burden may achieve prolonged response on ET.