Breast (Dec 2021)

Treatment and outcomes of older versus younger women with HER2-positive metastatic breast cancer in the real-world national ESME database

  • Mylène Annonay, MD,
  • Lisa Gauquelin, MD,
  • Romain Geiss, MD,
  • Mony Ung, MD,
  • Laurence Cristol-Dalstein, MD,
  • Marie-Ange Mouret-Reynier, MD PHD,
  • Anthony Goncalves, MD PHD,
  • Sophie Abadie-Lacourtoisie, MD,
  • Eric Francois, MD,
  • Christophe Perrin, MD,
  • Johan Le Fel, MD,
  • Véronique Lorgis, MD,
  • Véronique Servent, MD,
  • Lionel Uwer, MD,
  • Christelle Jouannaud, MD,
  • Marianne Leheurteur, MD,
  • Florence Joly, MD PHD,
  • Loic Campion, MD,
  • Coralie Courtinard, MPH,
  • Olivier Villacroux, MD,
  • Thierry Petit, MD PHD,
  • Pierre Soubeyran, MD,
  • Catherine Terret, MD,
  • Carine Bellera, PHD,
  • Etienne Brain, MD PHD,
  • Suzette Delaloge, MD MPH

Journal volume & issue
Vol. 60
pp. 138 – 146

Abstract

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Background: Treatment and outcomes of patients with HER2-positive (HER2+) metastatic breast cancer (MBC) have dramatically improved over the past 20 years. This work evaluated treatment patterns and outcomes according to age. Methods: Women who initiated a treatment for HER2+ MBC between 2008 and 2016 in one of the 18 French comprehensive centers part of the ESME program were included. Objectives were the description of first-line treatment patterns, overall survival (OS), first-line progression-free survival (PFS), and prognostic factors among patients aged 70 years or more (70+), or less than 70 (<70). Results: Of 4045 women diagnosed with an HER2+ MBC, 814 (20%) were 70+. Standard first-line treatment (chemotherapy combined with an anti-HER2 therapy) was prescribed in 65% of 70+ versus 89% of <70 patients (p < 0.01). Median OS was 49.2 (95% CI, 47.1–52.4), 35.3 (95% CI, 31.5–37.0) and 54.2 months (95% CI, 50.8–55.7) in the whole population, in patients 70+ and <70, respectively. Corresponding median PFS1 were 12.8 (95% CI, 12.3–13.3), 11.1 (95% CI, 10.0–12.3) and 13.2 months (95% CI, 12.7–13.9), respectively. In 70+ women, initiation of non-standard first-line treatment had an independent detrimental time-varying effect on both OS and PFS (HR on OS at 1 year: chemotherapy without anti-HER2 2.79 [95% CI: 2.05–3.79]; endocrine therapy and/or anti-HER2 1.96 [95% CI: 1.43–2.69]). Conclusions: In this large retrospective real-life database, older women with HER2+ MBC received standard first-line treatment less frequently than younger ones. This was independently associated with a worse outcome, but confounding factors and usual selection biases cannot be ruled out.

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