Treatment pattern by hormone receptors and HER2 status in patients with metastatic breast cancer in the United Kingdom, Germany, France, Spain, and Italy (EU-5): Results from a physician survey.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 570-570 ◽  
Author(s):  
Mitch DeKoven ◽  
Vijayveer Bonthapally ◽  
Won Chan Lee ◽  
Prathamesh Pathak ◽  
Xiaolong Jiao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Targeted Therapy ◽  
Triple Negative ◽  
Specific Treatment ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Her2 Status ◽  
The Uk ◽  
The Eu

570 Background: The differences in country-specific treatment patterns across Europe for Stage IV metastatic breast cancer (mBC) patients have not been extensively studied. This study compared treatment choices, by biomarker status, between various lines of therapy (LOT) in clinical practice in the EU-5 countries among newly diagnosed stage IV mBC patients. Methods: The IMS LifeLink Oncology Analyzer (OA) database, based upon practicing oncologist surveys, was used to identify mBC patients aged ≥21 and surveyed between July 2008 – June 2010. The database encompasses over 100,000 unique patients per year, treated by nearly 3,000 physicians, including nearly 60,000 patients and 800 physicians in the EU5. Results: A total of 152,311 mBC patients were included in the study. In Italy, 30.8% of HER2+/HR+ patients received chemotherapy following mBC diagnosis, as compared to only 8.6% in France. The majority of these patients in France received chemotherapy plus a HER2 targeted therapy (58.2%) as their first treatment. For HER2+/ HR- patients, chemotherapy plus a HER2 targeted therapy was provided to the majority of the patients in France (70.8%), with the UK providing this regimen to the fewest patients with this biomarker status (44.9%). Monotherapy hormonal regimens were given as a first LOT for HER2-/HR+ patients (UK 64.7%, Spain 52.8%). Triple negative patients received chemotherapy (UK 84.1% as compared to France 57.3%) or chemotherapy plus bevacizumab (France 36.6% as compared to UK 0.9%) as a first treatment. Conclusions: Thisstudy confirmed that chemotherapy combined with HER2-targeted therapy was the most frequent initial treatment option for HER2+ patients, while the vast majority of ER/PR+ patients were initially treated by hormonal therapy, suggesting that a personalized medicine approach has been accepted in the EU-5. However, the use of HER2-targeted therapy and bevacizumab greatly varied; while they were most frequently used in France, they were least frequently opted for in the UK. Also, fewer treatment options existed for triple negative patients and patients with HER2+ disease following trastuzumab treatment.

Cancer disparities among patients with advanced metastatic breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18566-e18566
Author(s):  
Diana Saravia ◽  
Leah Elson ◽  
Hong Liang ◽  
Nadeem Bilani ◽  
Elizabeth Blessing Elimimian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Hormonal Therapy ◽  
Triple Negative ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Patient Characteristics ◽  
Receptor Status ◽  
Risk Of Death

e18566 Background: We previously elucidated sociodemographic factors associated with risk-of-death, in a subgroup of patients with Stage IV human epidermal growth factor 2 (HER)+ breast cancer. To further understand determinants of disparities in all subgroups of stage IV breast cancer, this study sought to evaluate factors which are predictive of overall survival (OS) in a cohort of patients with metastatic breast cancer (MBC), according to the following subtypes: 1) estrogen receptor (ER)+ or progesterone receptor (PR)+ and (HER)-, (2) (ER+ or PR+) and HER+, (3) (ER- and PR-) and HER-, or (4) (ER- and PR-) and HER+. Methods: Study population included patients with MBC, extracted from the National Cancer Database, treated between 2010 and 2016. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were performed to compare patient characteristics, by ethnic group (white, black, Hispanic, Asian, and other). Multivariate Cox regression models with backward elimination (using significance level of p<0.05) were utilized to compare overall survival among patient cohorts. In addition, Kaplan-Meier survival curves of patient cohort were also produced. Statistics were performed using SAS. Results: Records from n= 47,032 patients were included, the majority were 50 years or older, white, and treated with hormonal therapy. With a median follow-up time of 2.3 years, disparities in OS were observed; black patients were more likely to suffer death (HR=1.12 (1.08-1.16), p<0.0001), compared to white patients. Additional factors contributing to risk of death in MBC included: being male (HR=1.12, (1.02-1.23), p=0.019), having visceral involvement compared to bone only (HR=1.52, (1.05-1.28), p<0.0001), income < $38,000 (HR=1.13 (1.09-1.17), p<0.0001), being on government insurance (HR=1.24, (1.20-1.27), p<0.0001, and having Triple Negative Breast Cancer (ER- and PR-) and HER- status (HR=1.68 (1.60-1.75) p<0.0001). Patients who receive chemotherapy, not hormonal therapy (HR=1.25 (1.2 – 1.3), p<0.0001), were found to have worse prognosis possibly reflecting biology of disease at presentation and lack of specific targeted therapy. Conclusions: This study confirms that sociodemographic disparities exist in OS among patients within the same stage of MBC, and regardless of receptor status subtypes. Clinical practice should focus on closing disparities gaps for those with advanced and MBC, especially among Black, impoverished, and male patients. Better treatment approaches should be sought for patients with visceral metastasis and those diagnosed with triple negative receptor status, who continue to suffer from worse outcomes.

DETECT III: A multicenter, randomized, phase III study to compare standard therapy alone versus standard therapy plus lapatinib in patients (pts) with initially HER2-negative metastatic breast cancer but with HER2-positive circulating tumor cells (CTC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS1146-TPS1146
Author(s):  
Carsten Hagenbeck ◽  
Carola Anna Melcher ◽  
Johann Wolfgang Janni ◽  
Andreas Schneeweiss ◽  
Peter A. Fasching ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Targeted Therapy ◽  
Clinical Benefit ◽  
Standard Treatment ◽  
Metastatic Breast ◽  
Phase Iii ◽  
Her2 Status ◽  
Her2 Positive ◽  
Phase Iii Study

TPS1146 Background: HER2 status may change over the course of disease in breast cancer pts. Approx. 20-30% of pts with initially HER2-negative breast cancer have HER2-positive metastasis (Zidan et al. 2005; Tewes et al. 2009). Determining HER2 status on CTC is one option to re-evaluate HER2 status at the time metastasis is diagnosed. Currently it is unclear if HER2-targeted therapy based on the assessment of HER2 status of CTC reveals a clinical benefit. Methods: This is a randomized, open-label, two arm phase III study to investigate the clinical efficacy of lapatinib, as a HER2-targeted therapy in initially HER2-negative metastatic breast cancer pts with HER2-positive CTC at the time of distant disease. As only half of the pts with HER2-negative metastatic breast cancer show CTC-positivity and of those approx. 32% will exhibit HER2-positive CTC (Fehm et al. 2010), screening of about 1420 pts is required to enroll 228 pts. Main inclusion criteria: metastatic breast cancer with HER2-negative primary tumor tissue and/or biopsies from metastatic sites or locoregional recurrences, evidence of ≥1 HER2-positive CTC and ≥1 measurable metastatic lesion according to RECIST. Eligible pts will be randomized 1:1 to receive standard treatment vs. standard treatment plus lapatinib. Standard chemo- or endocrine therapy must be approved in combination with lapatinib or been investigated in prior clinical trials. Primary endpoint is progression free survival. Secondary endpoints include overall response rate, clinical benefit rate, overall survival and dynamic of CTC. The DETECT III trial is one of the first trials where treatment is based on phenotypic characteristics of CTC. If this trial succeeds in proving efficacy of lapatinib in pts with initially HER2-negative metastatic breast cancer but HER2-positive CTC, this will establish a new strategy in the treatment of metastatic breast cancer.

Time of disease control (TDC) with hormone and chemotherapy in metastatic breast cancer (MBC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11069-e11069
Author(s):  
Hitesh Singh ◽  
David Hodges ◽  
Jana Reynolds ◽  
Pandora Ashley ◽  
Christopher O. Ruud
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Hormone Therapy ◽  
Triple Negative ◽  
Metastatic Breast ◽  
Hormone Treatment ◽  
Her2 Status ◽  
Start Date ◽  
Chemotherapy Administration ◽  
Line Of Therapy

e11069 Background: Patients with metastatic breast cancer are treated with multiple lines of therapy. Less is known about the relative benefits from subsequent lines of hormone and chemotherapy and the influence of the molecular subtypes; luminal, HER2, and triple negative. Methods: The tumor registry at Scott & White Memorial Hospital (S&W) was queried for consecutive patients diagnosed with MBC between 2000 and 2009. Of the 409 patients identified, 252 patients met inclusion criteria. Exclusions were partial treatment at S&W (112), unknown ER or HER2 status (26), male sex (5), and palliative care only (14). Treatment regimen and start date was recorded for each line of therapy by review of EMRs. TDC for each line was defined as the treatment start date to the date of the next line of therapy, or the end date of treatment for the final line. Lines of therapy were reported sequentially relative to their order in either hormone or chemotherapy, not in regard to their overall line in systemic treatment. Results: For patients followed to death, median overall survival for luminal (104), HER2 (57), and triple negative (62) was 19.0, 24.1, and 9.3 months respectively. For those who underwent chemotherapy as their final line (162), the median time between last chemotherapy administration and death was 1.5 months. The table reports the median TDC for the first five lines of chemotherapy and first three lines of hormone therapy. Conclusions: All subtypes had continued benefit of chemotherapy on subsequent chemotherapy lines. Overall, HER2 exhibited longer TDCs on chemotherapy. Although biased by case selection, TDC on hormone therapy was superior to chemotherapy for the first three lines of hormone treatment. Our findings support the benefit of successive lines of hormone and chemotherapy for palliation in MBC. [Table: see text]

Discordant ER, PR, and HER2 status between primary and metastatic breast cancer as prognostic factor.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1039-1039
Author(s):  
Hee-Chul Shin ◽  
Wonshik Han ◽  
Hyeong-Gon Moon ◽  
Seock-Ah Im ◽  
Woo Kyung Moon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Primary Breast Cancer ◽  
Triple Negative ◽  
Cancer Survival ◽  
Metastatic Breast ◽  
Her2 Status ◽  
Primary Tumors ◽  
Receptor Status

1039 Background: The receptor status including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) of metastases may be different from that of the primary breast cancer. This discordance of receptor status may influence patient prognosis. We investigated discordance of receptor status between primary breast cancer and distant metastases in the same patients and its effect on prognosis. Methods: ER, PR, and HER2 status in metastases were available in 173 patients. The receptor status was compared between primary tumors and metastases. Tumors were classified as triple-negative breast cancer (TNBC) or non-triple-negative breast cancer (non-TNBC) according to receptor status and as concordant and discordant depending on the difference of receptor status between primary and metastatic breast cancer. Survival analysis was performed depending on concordant or discordant receptor status. Results: Discordance for ER, PR, and HER2 was 18.5%, 23.7%, and 10.4%, respectively. Concordant non-TNBC and TNBC between primary tumors and metastases was 69.9% and 17.9%, respectively. Discordant TNBC was 12.1%. On multivariate analysis, patients with discordant TNBC had unfavorable survival compared with patients with concordant non-TNBC (relative risk 2.544, 95% confidence interval, 1.220-5.303, p = 0.013). The median survival after recurrence was 41.8 months for patients with concordant non-TNBC, 20.7 months for patients with concordant TNBC, and 19.9 months for patients with discordant TNBC (p < 0.0001). Conclusions: The change of ER, PR, and HER2 status between primary and metastatic tumors occur and discordant TNBC is associated with poor survival.

Phase II study of irinotecan plus capecitabine in patients with anthracycline and taxane pretreated metastatic breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1093-1093
Author(s):  
K. S. Lee ◽  
J. Ro ◽  
I. H. Park ◽  
E. A. Kim ◽  
B. Nam
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Triple Negative ◽  
Single Agent ◽  
Objective Response ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Phase Iii ◽  
Cross Resistance ◽  
Median Response

1093 Background: Irinotecan (I) and capecitabine (X) have demonstrated single agent activity against breast cancer by different antitumor mechanism without cross-resistance. To assess the objective response rate (RR) of IX combination in metastatic breast cancer (MBC) patients (pts) was the primary end point. Methods: Anthracycline- and taxane-pretreated pts with measurable disease, age ≥ 18 years, adequate organ functions, and ECOG performance score (PS) 0–2 were eligible. Sample size of 36 was calculated with Simon's two stage minimax design. Pts received I 80 mg/m2 intravenously on days 1 and 8 and X 1,000 mg/m2 orally twice daily on days 1–14 of every 21-day cycle. Results: Between September 2006 and April 2008, 36 pts with median age of 50 years (range, 28–71) were enrolled. Median follow-up was 17 months (range, 8.3+ - 27.7+). Among 35 evaluable pts excluding 1-consent withdrawal, 86% received at least one prior chemotherapy for MBC; 20% had stage IV disease with 66% lung/37% liver metastases; 80% had PS 0–1; 77% had hormone receptor (HR) positive tumors, 20% triple negative disease and 3% HER-2 positive tumors. Overall RR was 60% (95% CI, 43.5–74.5) with median response duration of 6.3 months (range, 1.0+-17.1+); 2 CR (6%), 19 PR (54%), 8 SD (23%), and 6 PD (17%) with similar RR between HR+ (63%) versus triple negative disease (57%). Median survival was not reached with 76% estimated survival at 1-year, and median progression free survival (PFS) was 7.3 months (range, 0.7–21.1+). Pts received a median of 8 cycles of treatment (range, 1–26+). G1, G2, and G3 hand-foot syndrome were observed in 34%, 17%, and 0%, respectively. NCI grade ≥ 3 adverse events were: neutropenia (60%); asthenia, diarrhea, and vomiting (9%, each); transaminase elevation and febrile neutropenia (6%, each); abdominal pain, anorexia, fatigue, myalgia, and nausea (3%, each). Conclusions: I and X combination by this schedule and doses is highly efficacious in anthracyline- and taxane-pretreated MBC pts with manageable toxicities. Further investigation of this combination in phase III trials is warranted. No significant financial relationships to disclose.

Visualizing treatment patterns and survival in metastatic breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 316-316
Author(s):  
Aidan Gilbert ◽  
Courtney Williams ◽  
Pravinkumar Kandhare ◽  
Arie Nakhmani ◽  
Stephen C. Meersman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Targeted Therapy ◽  
Quantitative Methods ◽  
Metastatic Breast ◽  
Treatment Patterns ◽  
Her2 Status ◽  
Duration Of Treatment ◽  
Treatment Sequencing ◽  
The Relationship

316 Background: Optimal treatment sequencing (i.e., the order in which drugs are given) for metastatic breast cancer (MBC) is unknown. We aimed to develop an approach to visualize treatment patterns and survival in MBC. Methods: This retrospective study utilized ASCO’s CancerLinQ Discovery® database generated from electronic health records. Subjects included 3,312 women aged ≥18 years who were diagnosed with and received treatment for MBC after 1980. Hormone receptor (HR) status was determined by concordant diagnosis and treatment records. Human epidermal growth factor (HER2) status was determined by delivery of HER2-targeted therapy. Ordered and administered treatments were included. We created spatiotemporal plots of treatment patterns for HR+/HER2-, HER2+, and triple negative (TN) MBC. Individuals were represented on the Y-axis, and time on the X-axis with development of MBC aligned at time 0. Treatment classes were identified by colors: hormone therapies in shades of red, chemotherapies in shades of blue, HER2-targeted therapies in shades of green, and novel therapies in shades of orange. Concurrent treatments were represented by split bars. An overlaid Kaplan-Meier curve allowed for observations about the relationship between survival and treatment. Results: We developed a novel visualization approach to simultaneously display heterogeneous, longitudinal treatments and survival. Median survival after first documentation of MBC was 3.1 (IQR 1.4-7.2), 1.3 (IQR 0.6-2.8), and 2.6 (IQR 1.0-5.2) years for HR+/HER2-, TN, and HER2+ MBC, respectively. Patients with longer survival often had long duration of initial therapy, suggesting a more indolent or responsive disease. Substantial heterogeneity in treatment sequencing was observed for HR+HER2- and TN cohorts. In the HER2+ cohort, HER2-targeted therapy was commonly administered for the duration of treatment with more homogeneous sequencing. Conclusions: This novel visualization approach allows for observing the relationship between treatment patterns and survival, which is challenging to demonstrate with traditional quantitative methods. This approach can generate hypotheses regarding impact of treatment patterns on survival.

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