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
Affiliations
Mylène Annonay, MD
Department of Medical Oncology, Institut Bergonié, Bordeaux, France
Lisa Gauquelin, MD
Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; Epicene Team (Cancer & Environnement), Bordeaux Population Health Center, ISPED, Centre INSERM U1219, INSERM, Bordeaux, France
Romain Geiss, MD
Department of Medical Oncology, Institut Curie, Saint-Cloud, France
Mony Ung, MD
Department of Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
Laurence Cristol-Dalstein, MD
Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
Marie-Ange Mouret-Reynier, MD PHD
Department of Medical Oncology, Centre Jean Perrin, Clermont Ferrand, France
Anthony Goncalves, MD PHD
Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
Sophie Abadie-Lacourtoisie, MD
Department of Medical Oncology, Institut de Cancérologie de l’Ouest Nantes & Angers, France
Eric Francois, MD
Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
Christophe Perrin, MD
Department of Medical Oncology, Centre Eugéne Marquis, Rennes, France
Johan Le Fel, MD
Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
Véronique Lorgis, MD
Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
Véronique Servent, MD
Department of Medical Oncology, Centre Oscar Lambret, Lille, France
Lionel Uwer, MD
Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
Christelle Jouannaud, MD
Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, Reims, France
Marianne Leheurteur, MD
Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
Florence Joly, MD PHD
Department of Medical Oncology, Centre François Baclesse, Caen, France
Loic Campion, MD
Oncology Data Factory and Analytics, Institut de Cancérologie de l’Ouest, France; CRCINA, University of Nantes, INSERM UMR 1232, CNRS-ERL6001, Nantes, France
Coralie Courtinard, MPH
Epicene Team (Cancer & Environnement), Bordeaux Population Health Center, ISPED, Centre INSERM U1219, INSERM, Bordeaux, France; Unicancer, Direction des Données, Paris, France
Olivier Villacroux, MD
Institut de Cancérologie de l’Ouest Nantes & Angers, France
Thierry Petit, MD PHD
Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
Pierre Soubeyran, MD
Department of Medical Oncology, Institut Bergonié, Bordeaux, France
Catherine Terret, MD
Department of Medical Oncology, Centre Leon Berard, Lyon, France
Carine Bellera, PHD
Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; Epicene Team (Cancer & Environnement), Bordeaux Population Health Center, ISPED, Centre INSERM U1219, INSERM, Bordeaux, France
Etienne Brain, MD PHD
Department of Medical Oncology, Institut Curie, Saint-Cloud, France
Suzette Delaloge, MD MPH
Department of Cancer Medicine, Gustave Roussy, Villejuif, France; Corresponding author. Department of Medical Cancer medicine, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
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.
