Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics

Abstract

Objectives To investigate breast cancer-specific mortality by early breast cancer (EBC; Stages I-IIIC) subtype; incidence of high-risk indicators for recurrence (defined in monarchE trial); and mortality risk difference by those who did/did not meet these criteria. Materials and methods Analyses included patients with initial EBC diagnosis between 2010–2015 from Surveillance, Epidemiology, and End Results (SEER) data (n = 342,149). Cox proportional hazards models and Kaplan-Meier estimates examined mortality among 228,031 patients, by subtype (hormone receptor [HR]-positive [+], human epidermal growth factor receptor-2 [HER2] negative [–]; triple negative [TNBC]; HR+, HER2+; HR-, HER2+). Incidence and mortality among patients who did/did not meet monarchE clinicopathological high-risk criteria were examined. Results Among patients with HR+, HER2- EBC, histologic Grade 3 (vs. Grade 1) was the most influential factor on mortality (hazard ratio, 3.61; 95%CI, 3.27, 3.98). Among patients with TNBC, ≥4 ipsilateral axillary positive nodes (vs. node negative) was the most influential factor on mortality (hazard ratio, 3.46; 95%CI, 2.87, 4.17). For patients with HR-, HER2+ or HR+, HER2+ EBC, tumor size ≥5 cm (vs. <1 cm) and ≥4 ipsilateral axillary positive nodes were the most influential factors on mortality. The 60-month mortality rate for the 12% of patients within the HR+, HER2- EBC group meeting monarchE clinicopathological high-risk criteria was 16.5%, versus 7.0% (Stage II–III and node positive) and 2.8% (Stage I or node negative) for those not meeting criteria. The 60-month mortality rate for patients with TNBC was 18.5%. Conclusion Mortality risk and the relative importance of risk factors varied by subtype. monarchE clinicopathological high-risk criteria were associated with increased mortality risk among patients with HR+, HER2- EBC. Patients with HR+, HER2- EBC, and monarchE clinicopathological high-risk criteria experienced risk of mortality similar to patients with early TNBC. These data highlight a high unmet need in this select patient population who may benefit most from therapy escalation.

Update Breast Cancer 2022 Part 5 – Early Stage Breast Cancer

“…3 a). With the focus on HRpos/HER2neg patients, sorting patients according to the MonarchE study inclusion and exclusion criteria showed that the patients channeled into the study MonarchE study made up approximately 13 % of all the HRpos/HER2neg patients investigated in this analysis [26]. Moreover, it was shown that after 6 years, patients with triple negative disease had a similar prognosis to those who were eligible for the MonarchE study (▶ Fig.…”

“…For example, the Mon- ▶ Fig. 3 a Breast cancer-specific survival according to groups defined by hormone receptor status and HER2 status (data from [26]). b Survival rates for TNBC patients and for HRpos/HER2neg patients who do and do not meet the inclusion criteria for the MonarchE study (data from [26]).…”

“…An analysis that made use of the American SEER database was able to show how patients with these characteristics fared in terms of breast cancer-specific survival compared to other patient groups. Over 342 000 patients in disease stages I-III took part in the analysis [26]. Compared to early-stage patients with positive HER2 status or with TNBC, patients with HR-positive/HER2-negative breast cancer clearly had the best breast cancer-specific survival (▶ Fig.…”

Mechanisms behind context-dependent role of glucocorticoids in breast cancer progression

“…Tumor grade (by assessment of histologic differentiation) and stage (TNM, Tumor size, Nodal status, and distant Metastasis) have also important prognostic roles and they are considered in a number of clinical decisions [ 2 ]. Early breast cancer accounts for > 90% of all diagnosed breast cancers and despite the availability of different treatment options, ~ 30% of these patients will develop cancer recurrence/progression [ 4 ]. Locally advanced or metastatic breast cancers have a median overall survival of approximately ∼3 years and the 5-year survival is only ∼25% [ 5 ].…”

Real-world study of patients with germline BRCA1/2-mutated human epidermal growth factor receptor 2‒Negative advanced breast cancer: Patient demographics, treatment patterns, adverse events, and physician-reported satisfaction in the United States, Europe, and Israel

“…Breast cancer is categorized into subtypes according to tumor characteristics, including hormone receptor (HR) status and human epidermal growth factor receptor 2 (HER2) overexpression, which support treatment decisions [ 6 , 7 ]. About two-thirds of BCs are HR positive (HR+), 13%–20% are HER2 positive, and 12% are classified as triple-negative BC (TNBC) [ [8] , [9] , [10] ]. Another factor that impacts BC risk and treatment options is the presence of germline mutations in BC susceptibility gene 1 or 2 (g BRCA1/2 mut).…”