Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

Zhanhong Chen; Quchang Ouyang; Yongsheng Wang; Junsheng Wang; Haixue Wang; Xiaohong Wu; Peili Zhang; Jian Huang; Yabing Zheng; Wenming Cao; Xiying Shao; Ning Xie; Can Tian; Hao Liang; Cailing Wang; Ying Zhang; Dianquan Ren; Xiaojia Wang

doi:10.3389/fonc.2022.829693

Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

Front Oncol. 2022 Mar 3:12:829693. doi: 10.3389/fonc.2022.829693. eCollection 2022.

Authors

Zhanhong Chen¹, Quchang Ouyang², Yongsheng Wang³, Junsheng Wang⁴, Haixue Wang⁵, Xiaohong Wu⁶, Peili Zhang⁷, Jian Huang¹, Yabing Zheng¹, Wenming Cao¹, Xiying Shao¹, Ning Xie², Can Tian², Hao Liang⁵, Cailing Wang⁴, Ying Zhang⁶, Dianquan Ren⁷, Xiaojia Wang¹

Affiliations

¹ Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.
² Department of Breast Cancer, Hunan Cancer Hospital, Changsha, China.
³ Department of Breast Surgery, Shandong Cancer Hospital, Jinan, China.
⁴ Department of Breast Cancer, Anyang Tumor Hospital, Anyang, China.
⁵ Department of Breast Surgery, Anyang Tumor Hospital, Anyang, China.
⁶ Department of Breast Cancer, Affiliated Hospital of Jiangnan University, Wuxi, China.
⁷ Department of Breast Surgery, Baotou Cancer Hospital, Baotou, China.

Abstract

Background: Recent data on first-line treatment patterns administered to hormone receptor-positive (HR+) advanced breast cancer (ABC) patients in the real-world setting are limited. This study aimed to report the first-line treatment patterns and outcomes of HR+ ABC patients in China.

Methods: This was a multicenter, noninterventional study. Eligible patients were cytologically or histologically confirmed to have HR+ ABC with ≥2 complete medical records and received first-line therapies between January 2015 and June 2019. Treatment patterns and outcomes were extracted from structured or unstructured electronic medical records. Progression-free survival (PFS) was analyzed with the Kaplan-Meier method.

Results: In total, 1072 patients with HR+ ABC were enrolled at 6 treatment sites: 327 human epidermal growth factor receptor 2-positive (HER2+) patients, 696 HER2-negative (HER2-) patients and 49 HER2-unknown patients. Overall, 62.41% of patients received first-line chemotherapy (CT), 21.08% received targeted therapy (TT) and 15.49% received endocrine therapy (ET). For HR+/HER2+ patients, 65.14% received TT, 28.44% received CT, and 5.81% received ET. Compared with patients who received TT, patients who received CT alone, had a significantly worse median PFS (adjusted hazard ratio [HR] =2.59, 95% confidence interval [CI], 1.64-4.10, p<0.001). For HR+/HER2- patients, 77.01% received CT, 20.69% received ET and 1.15% received TT. Compared with patients who received ET, patients who received CT with maintenance therapy had a significantly prolonged median PFS (adjusted HR =0.57, 95% CI, 0.44-0.76, p<0.001). Among HR+/HER2- patients who received CT with maintenance treatment, those with maintenance ET had a longer median PFS than those with maintenance CT, but the difference was not significant (adjusted HR=0.92, 95% CI, 0.64-1.33, p=0.66).

Conclusions: This real-world study demonstrates that CT remains the mainstream first-line treatment option for HR+ patients in China. Among patients with HR+/HER2+ ABC, the majority received first-line TT and experienced a PFS benefit. A high percentage of HR+/HER2- patients received CT as first-line therapy in clinical practice. PFS benefit was significantly longer in patients who received CT with maintenance therapy. Moreover, there was no obvious difference in PFS between maintenance ET and CT. Maintenance ET may be a better choice considering its lower toxicity and better quality of life.

Keywords: advanced breast cancer; first-line treatment; hormone receptor-positive; outcomes; real-world study.