2023-08-04 15:27:58
Why is this important?
Breast cancer called “triple negative” defined by the absence of expression of estrogen and progesterone receptors, and by the absence of overexpression of the HER2 protein or gene amplification, remains the subtype of breast cancer most aggressive breast. The absence of an identified recurrent genomic factor is accompanied by a lack of specific targeted treatment. Distant metastases occur mainly in the viscera (brain, lung, liver). Real-life data helps describe patients, treatments and outcomes for populations that are often underrepresented in clinical trials.
Methodology
All subjects diagnosed with metastatic triple-negative breast cancer relapse between 2008 and 2020, following neoadjuvant/adjuvant therapy with taxane and/or anthracycline, were included. An early relapse was defined by a diagnosis of metastases within 12 months following the end of neoadjuvant/adjuvant treatment with taxanes and/or anthracycline. Overall survival (OS) and progression-free survival (PFS) under first-line treatment were assessed and compared between patients with early and late relapse (≥12 months).
Principle results
Of a total population of 30,459 women who initiated treatment for metastatic triple-negative breast cancer, 1,926 had a relapse of metastatic breast cancer following receiving neoadjuvant/adjuvant therapy with taxanes and/or anthracyclines and were eligible for the study. Among them, 45.7% had an early relapse. These were significantly younger (51 years versus 56 years), less often had a germline BRCA1/2 mutation at the time of metastatic diagnosis (5.6% versus 7.6%) and had a larger primary tumor (T3/T4 49.6% versus 31.5%) and more significant lymph node invasion (N2/N3 23.1% versus 8.7%), and slightly fewer metastatic sites than those who had a late relapse. On the other hand, the type of metastatic attack was similar (17% cerebral, 51-54% visceral).
Women with metastatic triple-negative breast cancer in early relapse were as likely to have been included in a clinical trial for their first-line metastatic treatment as the others (17%).
The early relapse rate was found to be quite stable over time between 2008 and 2020.
The median duration of follow-up for the entire sample was 57.6 months. Median overall survival was 10.1 months [9,3-10,9] for patients with an early relapse and 17.1 months [15,7-18,2] months for those who had a late relapse (hazard ratio (HR) 1,70 [1,54-1,88]p<0,001). La survie médiane sans progression de la maladie était de 3,1 mois [2,9-3,4] and 5.3 months [5,1-5,8] respectively (HR 1.60 [1,46-1,75]p<0,001).
In multivariate analysis, on the whole population, the age at diagnosis of the metastatic stage, the number of metastatic sites at diagnosis, the presence of visceral metastases and the exposure to taxanes in neo/adjuvant treatment, were factors independently associated with median overall survival.
In multivariate analysis, time to relapse (0-6 months versus 6-12 months) and the number of metastatic sites were found to be independent prognostic factors for progression-free survival.
Funding
Study funded by an industrial consortium (Roche, Pfizer, AstraZeneca, MSD, Eisai and Daiichi Sankyo).
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