Objective Response to First-Line Treatment as a Predictor of Overall Survival in Metastatic Breast Cancer: A Retrospective Analysis from Two Centers over a 25-Year Period

Matikas, Alexios; Κotsakis, Athanasios; Perraki, Maria; Hatzidaki, Dora; Kalbakis, K.; Kontopodis, Emmanouil; Nikolaou, Michail; Georgoulias, V.

doi:10.1159/000519729

Cited by 4 publications

(6 citation statements)

References 39 publications

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“…Remarkably, nearly half of the study cohort did not receive any antitumoral treatment, an observation previously described in another patient cohort [ 36 ]. As a result, these women did not get the opportunity of the potential benefits of modern therapy.…”

Section: Discussionmentioning

confidence: 89%

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

Boman

Kessler

Bergh

et al. 2022

Breast Cancer Res Treat

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Purpose Despite therapeutic advances, overall survival of metastatic breast cancer (MBC) at the population level has seen little improvement over the past decades. Aggressive tumor biology or delay in access to cancer care might be contributing factors. With this retrospective population-based study we aimed to quantify and characterize patients with very short survival time following MBC diagnosis. Methods Women diagnosed with MBC between Jan 1st, 2005 and Dec 31st, 2016 were identified using the population-based Stockholm–Gotland breast cancer registry. Data regarding demographic and clinicopathological characteristics, survival, and treatment were extracted retrospectively from the registry and from patient charts. Patients who died within 90 days following diagnosis of MBC were identified and their characteristics were compared with all other patients diagnosed with MBC during the same period. Results Between 2005 and 2016, 3124 patients were diagnosed with MBC, of whom 498 (16.2%) died within 90 days of diagnosis. Nearly half (N = 233) did not receive any antitumoral treatment. Patients with short survival were older (p < 0.001), had higher primary tumor grade (p < 0.001), higher clinical stage at primary diagnosis (p = 0.002), and more often estrogen receptor (ER)-negative breast cancer (p < 0.001). Visceral metastases were more frequent (p < 0.001) and patients with short survival received adjuvant chemotherapy (p < 0.001) to a lesser extent compared to patients with a better prognosis. In multivariable analysis older age, time period of diagnosis, metastasis site, adjuvant chemotherapy, and primary tumor grade were independent predictors for short survival, whereas ER status was not. Conclusion Nearly one out of six patients with MBC survive less than 3 months after diagnosis. Our findings demonstrate a different spectrum of MBC at population level and can potentially inform on individualized follow-up strategies and treatment algorithms.

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Section: Discussionmentioning

confidence: 89%

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

Boman

Kessler

Bergh

et al. 2022

Breast Cancer Res Treat

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“…This may be explained by resistance to chemotherapy or hormonal therapy, toxicity, or intolerance to treatment from the first line to later ones. was a predictive factor for longer PFS 1 (HR 0.57; 95% CI, 0.42-0.76; p < 0.001) [16], [18].…”

Section: Discussionmentioning

confidence: 96%

Factors Affecting Treatment Outcome of Metastatic Breast Cancer: Single Institution Study

shamsaldin

Abdelmalek

Ibrahim³

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: Metastatic breast cancer (MBC) is an incurable disease. AIM: The goal of therapy is to prolong survival and amelioration of quality of life. However, the benefit of later systemic treatment lines is not clear. METHODS: This was a retrospective study of 345 MBC patient., assessment of progression free survival (PFS) survival with first line of treatment and second, third, fourth, fifth, and sixth lines of therapy, and analysis of different prognostic factors. RESULTS: The median overall survival (OS) was 31.7 month. The median PFS was 8.1 versus 3 month for first line of treatment and beyond. Where median PFS1, PFS 2, PFS 3, PFS 4, PFS 5, and PFS 6 were 8.1, 5.8, 3.8, 4.8, 3.4, and 2.6, respectively. PFS of first line was significantly prolonged in hormone positive luminal subtype, bone only metastasis, age above 35, ECOG I-II, and oligometastatic (p = 0.041, 0.038, 0.023, 0.034, 0.0001, and 0.001, respectively). Post-progression survival was 23.4 months and it was significantly prolonged in hormone positive luminal subtype, bone only metastasis, age above 35, ECOG I-II and PFS more than 6 months with first line. CONCLUSION: PFS is reduced with using more treatment lines in MBC. Patients with luminal subtype, bone only metastasis, age above 35, ECOG I-II, and PFS more than 6 months with first line may have the best benefit from later lines.

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“…Both everolimus and alpelisib are active in MBC and work on the same PI3K/AKT/mTOR axis, but the ideal sequencing to minimize treatment resistance is unknown, and even the new ESMO guidelines cannot recommend the best sequencing beyond the first line [ 7 ]. The PFS rates in the advanced treatment lines usually shorten from line-to-line of treatment [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…ESR1 mutations are associated with resistance to hormonal treatment [ 8 ]. In addition, Razavi et al [ 10 ] reported, among the patients with HR+ MBC who participated in a phase I/II study of alpelisib in combination with letrozole or exemestane, that ESR1-activating mutations increased during treatment, and were associated with a resistance to the combination.…”

Section: Discussionmentioning

confidence: 99%

Alpelisib Efficacy in Hormone Receptor-Positive HER2-Negative PIK3CA-Mutant Advanced Breast Cancer Post-Everolimus Treatment

Raphael

Salmon‐Divon

Epstein

et al. 2022

Genes

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This real-world cohort analysis assessed the efficacy of alpelisib and endocrine treatment (ET) combinations in a post-everolimus setting. Thirteen women who started alpelisib and ET at standard doses between 2018 and 2022 for advanced breast cancer (ABC), after undergoing CDK4/6i and everolimus treatment, were eligible for the study entry. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were the objective response rate (ORR) and clinical benefit rate (CBR), with different molecular profiling. The patients had previously received a median of four (range 3–8) systemic treatments, including CDK4/6i and everolimus. The median PFS on alpelisib was 5.5 months (range 0.5–10), and four women each had an ORR and three (23%) had a stable disease. The 6-month CBR was 46.1%, similar to the BYLeive study cohort C (47.8%). Notably, our cohort included patients with a long CBR under everolimus treatment (median 6 months, range 1–18); however, the responses to alpelisib and everolimus were not correlated (Pearson r = −0.23, p = 0.44). The PIK3CA, P53, ARID, GATA3, and ESR1 mutations were not associated with the 6-month CBR. Despite heavy pre-treatments, including everolimus, alpelisib was clinically relevant in our cohort, even among patients with an ESR1 mutation. The best treatment sequence for PIK3CA/mTOR inhibitors warrants examination in future trials on PIK3CA-mutant inpatients with luminal ABC.

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Objective Response to First-Line Treatment as a Predictor of Overall Survival in Metastatic Breast Cancer: A Retrospective Analysis from Two Centers over a 25-Year Period

Cited by 4 publications

References 39 publications

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

Factors Affecting Treatment Outcome of Metastatic Breast Cancer: Single Institution Study

Alpelisib Efficacy in Hormone Receptor-Positive HER2-Negative PIK3CA-Mutant Advanced Breast Cancer Post-Everolimus Treatment

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