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Old 12-07-2019, 01:39 PM   #1
Lani
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Join Date: Mar 2006
Posts: 4,774
Outcomes in HR+/HER2+ Metastatic Breast Cancer Pts: A Natnl Cancer Database Analysis

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Sci Rep. 2019 Dec 2;9(1):18126. doi: 10.1038/s41598-019-54402-9.
Real-world Treatment Patterns and Outcomes in HR+/HER2+ Metastatic Breast Cancer Patients: A National Cancer Database Analysis.
Statler AB1, Hobbs BP2, Wei W2, Gupta A3, Blake CN4, Nahleh ZA5.
Author information

1
Cancer Biostatistics, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
2
Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
3
Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA.
4
Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA.
5
Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA. nahlehz@ccf.org.

Abstract

Treatment patterns and outcomes are unclear for metastatic breast cancer (MBC) patients diagnosed with hormone receptor-positive (HR+), human epidermal growth factor 2-positive (HER2+) disease. This study aimed to: (1) examine the utilization of first-line therapy among HR+/HER2+/MBC patients and (2) compare overall survival (OS) between the identified regimens. We analyzed National Cancer Database patients (HR+/HER2+/MBC) who were treated between 2010 and 2015. Multivariable logistic and Cox regression were used to: (1) identify independent predictors of treatment receipt and (2) determine significant prognostic factors for OS. Kaplan-Meier method and log-rank test were used to estimate and evaluate OS, respectively. Propensity scores were added to all multivariate OS models, thereby accounting for bias in treatment receipt. Of 6,234 patients analyzed, 3770 (60.5%) received hormonal therapy and 2464 (39.5%) received chemotherapy. Receipt of hormonal therapy was associated with older age, grade 1/grade 2 disease, no visceral involvement, higher comorbidity scores, and being white. Multivariate analysis suggest patients receiving hormonal therapy + anti-HER2 experienced improved OS, when compared to chemotherapy + anti-HER2 (HR: 0.74, p = 0.004). Overall, the cohort receiving hormonal therapy + anti-HER2 reported the highest 5-year OS (hormonal + anti-HER2: 47.5% vs. chemotherapy + anti-HER2: 39.8% vs. hormonal: 38.5% vs. chemotherapy: 36.3%, p < 0.001). Our findings suggest de-escalated therapy may be the preferred and potentially more effective care path for HR+/HER2+/MBC patients, signaling a need for randomized studies.

PMID:
31792304
DOI:
10.1038/s41598-019-54402-9

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