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Old 05-19-2014, 10:03 AM   #1
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Post Advanced luminal breast cancer: Who receives chemotherapy as first-line systemic trea

Advanced luminal breast cancer: Who receives chemotherapy as first-line systemic treatment?

Abstract No:
Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2014 ASCO Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Marta Bonotto, Lorenzo Gerratana, Mauro Mansutti, Stefano Moroso, Stefania Russo, Donatella Iacono, Alessandro Minisini, Gianpiero Fasola, Fabio Puglisi; Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine - Department of Medical and Biological Sciences, University of Udine, Udine, Italy; University Hospital of Udine, Udine, Italy
Abstract Disclosures


Background: Luminal subtypes, divided into 'luminal A' and 'luminal B', are the most prevalent form of breast cancer (BC). Notably, luminal BCs are heterogeneous in terms of molecular characteristics and, ultimately, in terms of patient outcomes. Endocrine therapy (ET) and chemotherapy (CT) are both suitable options as first-line treatment of luminal metastatic BC (MBC). Few data are available about factors that are used in the decision-making process of whether or not to give CT instead of ET, and viceversa, in this patient population. Methods: The study included 335 consecutive patients with ER-positive and/or PgR-positive MBC treated at the Department of Oncology of Udine, Italy, from 2004 to 2013. The cut-off point of 1% was used to define ER and/or PgR positivity. Patient-related and disease-related factors were examined to test the association with first-line treatment choice (ET vs. CT). Results: First-line CT was chosen for 42% of patients. On multivariate analysis, HER2-positivity (OR 11.21, 95%C.I. 3.45-36.473, P<0.0001) and presence of liver metastases (OR 2.29, 95%C.I. 1.08-4.86, P=0.03) were determinants of CT use. Conversely, postmenopausal status (OR 0.35, 95%C.I. 0.14-0.89, P=0.02), age ≥70 years (OR 0.23, 95%C.I. 0.11-0.5, P=0.0002), worse performance status (ECOG 2 vs 0/1; OR 0.25, 95%C.I. 0.07-0.88, P=0.03) and bone only disease (OR 0.11, 95%C.I. 0.04-0.29, P<0.0001) favored ET use. Degree of receptor positivity, MIB-1 status, body mass index, previous treatment for early disease and presence of lung metastases were not associated with treatment choice. Notably, no differences were observed between CT and ET as first-line treatment either in terms of overall survival (OS)(39.94 months and 33.93 months respectively, log-rank test, P=0.3) or progression free survival (PFS) (11.44 months and 9.9 months respectively, log-rank test, P=0.27). Conclusions: The study showed that clinical patient characteristics significantly influenced the decision-making process for the first-line treatment of advanced luminal BC. However, identification of predictive factors that could optimize therapeutic choice is eagerly awaited.
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