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Clinical pattern of primary systemic therapy and outcomes of estrogen receptor-positive, HER2-negative metastatic breast cancer: a review of a single institution

  • Epidemiology
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Abstract

Purpose

In the management of estrogen receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer (ER+HER2−MBC) patients, endocrine therapy (ET) is preferred to chemotherapy (CT) as a primary systemic therapy (PST) when tumor burden is not high. However, there are no definite criteria for choosing a PST, transitioning from ET to CT or using maintenance ET subsequent to CT.

Methods

We reviewed the medical records of 311 ER+HER2−MBC patients who underwent CT from September 2002 to December 2016 and assessed their outcomes.

Results

Of the 311 patients, 178 (57%) received ET as a PST (ET-first group), and 133 (43%) received CT prior to ET (CT-first group). The ET-first group showed a median overall survival (OS) from the diagnosis of MBC (OSMBC) of 1593 days, and the median OS from the initiation of CT (OSCT) was 938 days. Patients with visceral involvement, liver metastasis, soft tissue metastasis, ≥3 organ involvement, or primary advanced BC at the MBC diagnosis showed a significantly higher tendency to be assigned to the CT-first group (P < 0.01 for any visceral involvement, P < 0.05 for all others). Maintenance ET was available in 74 (55.6%) patients in the CT-first group, who showed a significantly better OSMBC and OSCT than patients without maintenance ET (median OSMBC 1423 and 867 days, respectively, P < 0.0001; median OSCT 1350 and 637 days, respectively, P < 0.0001).

Conclusion

Our findings suggest the possibility for changing the treatment paradigm of patients with ER+HER2−MBC, so a randomized prospective study is warranted to determine the optimum sequence of systemic therapies.

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Acknowledgements

A part of this article was presented at the poster sessions of the European Society of Medical Oncology (ESMO) 2016 Congress and the 2nd World Congress on Controversies in Breast Cancer (CoBrCa).

Funding

None declared.

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Authors and Affiliations

  1. Division of Breast Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shizuoka, 4118777, Japan

    Junichiro Watanabe

  2. Division of Breast Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    T. Hayashi, Y. Tadokoro, S. Nishimura & K. Takahashi

Authors
  1. Junichiro Watanabe
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  2. T. Hayashi
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  3. Y. Tadokoro
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  4. S. Nishimura
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  5. K. Takahashi
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Corresponding author

Correspondence to Junichiro Watanabe.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in full compliance of the laws and after obtaining approval from the Institutional Review Board of the Hospital where the study was conducted.

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Watanabe, J., Hayashi, T., Tadokoro, Y. et al. Clinical pattern of primary systemic therapy and outcomes of estrogen receptor-positive, HER2-negative metastatic breast cancer: a review of a single institution. Breast Cancer Res Treat 166, 911–917 (2017). https://doi.org/10.1007/s10549-017-4478-z

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  • DOI: https://doi.org/10.1007/s10549-017-4478-z

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