Therapeutic Advances in Medical Oncology (Dec 2020)

Management and outcome of male metastatic breast cancer in the national multicenter observational research program Epidemiological Strategy and Medical Economics (ESME)

  • Junien Sirieix,
  • Julien Fraisse,
  • Simone Mathoulin-Pelissier,
  • Marianne Leheurteur,
  • Laurence Vanlemmens,
  • Christelle Jouannaud,
  • Véronique Diéras,
  • Christelle Lévy,
  • Mony Ung,
  • Marie-Ange Mouret-Reynier,
  • Thierry Petit,
  • Bruno Coudert,
  • Etienne Brain,
  • Barbara Pistilli,
  • Jean-Marc Ferrero,
  • Anthony Goncalves,
  • Lionel Uwer,
  • Anne Patsouris,
  • Olivier Tredan,
  • Coralie Courtinard,
  • Sophie Gourgou,
  • Jean-Sébastien Frénel

DOI
https://doi.org/10.1177/1758835920980548
Journal volume & issue
Vol. 12

Abstract

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Background and Aims: Because of its low prevalence, metastatic breast cancer (MBC) in males is managed based on clinical experience with women. Using a real-life database, we aim to provide a comprehensive analysis of male MBC characteristics, management and outcome. Methods: The Epidemiological Strategy and Medical Economics Data Platform collected data for all men and women ⩾18 years with MBC in 18 participating French Comprehensive Cancer Centers from January 2008 to November 2016. Demographic, clinical, and pathological characteristics were retrieved, as was treatment modality. Men were matched 1:1 to women with similar characteristics. Results: Of 16,701 evaluable patients, 149 (0.89%) men were identified. These men were older (median age 69 years) and predominantly had hormone receptor HR+/HER2– disease (78.3%). Median overall survival (OS) was 41.8 months [95% confidence interval (CI: 26.9–49.7)] and similar to women. Median progression-free survival (PFS) with first-line therapy was 9.3 months [95% CI (7.4–11.5)]. In the HR+/HER2– subpopulation, endocrine therapy (ET) alone was the frontline treatment for 43% of patients, including antiestrogens ( n = 19), aromatase inhibitors ( n = 15) with luteinizing hormone-releasing hormone (LHRH) analogs ( n = 3), and various sequential treatments. Median PFS achieved by frontline ET alone was similar in men [9.8 months, 95% CI (6.9–17.4)] and in women [13 months, 95% CI (8.4–30.9)] ( p = 0.80). PFS was similar for HR+/HER2– men receiving upfront ET or chemotherapy: 9.8 months [95% CI (6.9–17.4)] versus 9.5 months [95% CI (7.4–11.7)] ( p = 0.22), respectively. Conclusion: MBC management in men and women leads to similar outcomes, especially in HR+/HER2– patients for whom ET should also be a cornerstone. Unsolved questions remain and successfully recruiting trials for men are still lacking.