tby
Annonay Mylène, Gauquelin Lisa, Geiss Romain, Ung Mony, Cristol-Dalstein
Laurence, Mouret-Reynier Marie-Ange, Goncalves Anthony, Abadie-Lacourtoisie
Sophie, Francois Eric, Perrin Christophe, Le Fel Johan, Lorgis Véronique,
Servent Véronique, Uwer Lionel, Jouannaud Christelle, Leheurteur Marianne, Joly
Florence, Campion Loic, Courtinard Coralie, Villacroux Olivier, Petit Thierry,
Soubeyran Pierre, Terret Catherine, Bellera Carine, Brain Etienne, Delaloge
Suzette
The Breast: VOLUME 60, P138-146, DECEMBER
01, 2021
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.
