Clinical pattern of primary systemic therapy and outcomes of estrogen receptor-positive, HER2-negative metastatic breast cancer: a review of a single institution

Watanabe, Junichiro; Hayashi, Takuma; Tadokoro, Yukiko; Nishimura, Seiichiro; Takahashi, Kaoru

doi:10.1007/s10549-017-4478-z

Cited by 17 publications

(20 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding supports the assumption that multiple metastases involving liver or brain metastasis is indicative of extensive spreading or dissemination of cancer cells, or lethal organ dysfunction, leading to poor survival outcomes [11,15,24]. In real-world practice, patients with multiple metastases are more likely to receive cytotoxic therapy because their vital organs are potentially damaged or in "visceral crisis" [19][20][21]. However, not all multiple metastases may lead to poor outcomes due to their own heterogeneity [19]; therefore, we should determine the most reliable and decisive prognostic factors for HR+/HER2-patients with multiple metastases.…”

Section: Discussionsupporting

confidence: 77%

“…In real-world practice, patients with multiple metastases are more likely to receive cytotoxic therapy because their vital organs are potentially damaged or in "visceral crisis" [19][20][21]. However, not all multiple metastases may lead to poor outcomes due to their own heterogeneity [19]; therefore, we should determine the most reliable and decisive prognostic factors for HR+/HER2-patients with multiple metastases.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Yamamura

Kamigaki

Fujita

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The initial therapeutic strategy for hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer is based on the first metastatic site, but little evidence is available regarding the influence of metastatic distribution patterns of first metastatic sites on prognosis. In this study, we aimed to identify the metastatic distribution patterns of first metastatic sites that significantly correlate with survival after recurrence. Methods: We performed a retrospective review of records from 271 patients with recurrent metastatic HR+/ HER2- breast cancer diagnosed between January 2000 and December 2015. We assessed survival after recurrence according to the metastatic distribution patterns of first metastatic sites and identified significant prognostic factors among the patients with single and multiple metastases. Results: Prognosis was significantly better in patients with single metastasis than those with multiple metastases (median overall survival after recurrence: 5.86 years vs. 2.50 years, p<0.001). No metastatic organ site with single metastasis was significantly associated with prognostic outcome, though single metastasis with diffuse lesions was an independent risk factor for worse prognosis (HR: 3.641; 95% CI: 1.856-7.141), and more easily progressed to multiple metastases (p=0.002). Multiple metastases including liver metastasis (HR: 3.145; 95% CI: 1.802-5.495) or brain metastasis (HR: 3.289; 95% CI: 1.355-7.937) were regarded as a significant independent poor prognostic factor, but multiple metastases not involving liver or brain metastasis were not significantly related to prognosis after recurrence. Conclusions: Single metastasis with diffuse lesions could more easily disseminate systemically and progress to multiple metastases, leading to poor prognosis similar to multiple metastases. The metastatic distribution patterns of first metastatic sites may be important clinical clues for achieving optimal initial treatment for recurrent metastatic HR+/HER2- breast cancer. Our findings indicate that reconsideration of the determinant factors of therapeutic strategies for first recurrence may be needed.

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Yamamura

Kamigaki

Fujita

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The proportion of patients receiving 1st LoT chemotherapy decreased over the study period from greater than 30% to less than 20%; although not statistically significant, this trend is of interest and worthy of further study. In a real-world study from the Netherlands, a quarter of patients with HR+ MBC between 2007 and 2009 received 1st LoT chemotherapy [19]; the figure was higher in similar studies from Italy (42%) [20], US (40%) [21] and Japan (43%) [22], suggesting differences in, and evolution of, practice over time between countries, despite the consistency of guidelines.…”

Section: Discussionmentioning

confidence: 97%

Systemic treatment of hormone receptor positive, human epidermal growth factor 2 negative metastatic breast cancer: retrospective analysis from Leeds Cancer Centre

et al. 2020

View full text Add to dashboard Cite

Background: Study aimed to characterise treatment and outcomes for patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC) within a large regional cancer centre, as a benchmark for evaluating real-world impact of novel therapies. Methods: Retrospective longitudinal cohort, using electronic patient records of adult females with a first diagnosis of HR+/HER2-MBC January 2012-March 2018. Results: One hundred ninety-six women were identified with HR+/HER2-MBC. Median age was 67 years, 85.2% were post-menopausal and median time between primary diagnosis and metastasis was 5.4 years. Most (75.1%) patients received endocrine therapy as first line systemic treatment (1st LoT); use of 1st LoT chemotherapy halved between 2012 and 2017. Patients receiving 1st LoT chemotherapy were younger and more likely to have visceral metastasis (p < 0.01). Median OS was 29.5 months and significantly greater for patients with exclusively non-visceral metastasis (p < 0.01). The adjusted hazard ratio for death of patients with visceral (or CNS) metastasis was 1.91 relative to those with exclusively non-visceral metastasis. Conclusions: Diverse endocrine therapies predominate as 1st LoT for patients with HR+/HER2-MBC, chemotherapy being associated with more aggressive disease in younger patients, emphasising the importance of using effective and tolerable therapies early.

show abstract

“…ET is the first choice for the treatment of patients with ER-positive metastatic BC (MBC) who only have bone metastases or asymptomatic visceral metastasis. 3 However, ER-positive MBC patients who are treated with ET often display markedly different responses. Relapse occurs within months after treatment in certain patients, whereas in others, relapse occurs after many years.…”

Section: Introductionmentioning

confidence: 99%

The predictive ability of plasma <em>ESR 1</em> mutations for the efficacy of endocrine therapy in hormone-receptor-positive advanced breast cancer

Jiao³

et al. 2018

OTT

View full text Add to dashboard Cite

PurposeThe predictive ability of plasma ESR1 mutations for outcomes among patients with advanced breast cancer undergoing endocrine therapy (ET) remains disputable. We performed a comprehensive meta-analysis of published studies to clarify the impact of plasma ESR1 mutations on clinical outcomes for patients after subsequent ET.Materials and methodsAn electronic search was performed to identify eligible studies. Studies analyzing progression-free survival (PFS) and/or overall survival (OS) according to plasma ESR1 mutation status after subsequent ET were included. HRs were calculated using a fixed- or random-effects model according to heterogeneity. Pooled HRs and 95% CIs were used to estimate the effects.ResultsSix studies including 705 patients with advanced breast cancer met the inclusion criteria. The impact of plasma ESR1 mutations on PFS and OS after subsequent ET was reported in six studies (seven groups) and two studies, respectively. Meta-analysis results showed that the pooled HR for ESR1 mutations was 1.70 (95% CI, 1.05–2.74; P=0.03) for OS, which was statistically significant for predicting poor survival, and 1.56 (95% CI, 1.13–2.14; P=0.006) for PFS; however, Begg’s and Egger’s test results identified the presence of bias. The trim-and-fill method was used, and after incorporation of the imputed studies, the HR was 1.16 (95% CI, 0.88–1.53, P=0.30) for PFS, which indicates that plasma ESR1 mutation had no effect on PFS after subsequent ET. Subgroup analysis suggested that plasma ESR1 mutations were correlated with shorter PFS (HR, 1.98; 95% CI, 1.12–3.51; P=0.02) in patients subsequently treated with aromatase inhibitors (AIs), whereas no association with PFS was observed for patients subsequently treated with non-AI ET (HR, 1.08; 95% CI, 0.85–1.38; P=0.54) or fulvestrant (HR, 1.03; 95% CI, 0.79–1.34; P=0.83).ConclusionThe current meta-analysis demonstrates that plasma ESR1 mutation status is not a predictor of ET efficacy for all drugs without distinction in patients with hormone-receptor-positive advanced breast cancer. ESR1 mutation predicted a poor response to AIs, whereas it was not predictive of non-AI ET efficacy, especially for fulvestrant.

show abstract

Clinical pattern of primary systemic therapy and outcomes of estrogen receptor-positive, HER2-negative metastatic breast cancer: a review of a single institution

Abstract: Our findings suggest the possibility for changing the treatment paradigm of patients with ER+HER2-MBC, so a randomized prospective study is warranted to determine the optimum sequence of systemic therapies.

Cited by 17 publications

References 14 publications

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

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

Systemic treatment of hormone receptor positive, human epidermal growth factor 2 negative metastatic breast cancer: retrospective analysis from Leeds Cancer Centre

The predictive ability of plasma <em>ESR 1</em> mutations for the efficacy of endocrine therapy in hormone-receptor-positive advanced breast cancer

Contact Info

Product

Resources

About