Disease management patterns for postmenopausal women in Europe with hormone-receptor-positive, human epidermal growth factor receptor-2 negative advanced breast cancer

Abstract

Background:

International guidelines for hormone-receptor-positive (HR⁺), human epidermal growth factor receptor-2 negative (HER2⁻) advanced breast cancer (BC) recommend sequential lines of hormonal therapy (HT), and only recommend chemotherapy for patients with extensive visceral involvement or rapidly progressive disease. This study evaluated actual physician-reported treatments for advanced BC in Europe.

Methods:

We conducted a retrospective chart review of 355 postmenopausal women with HR⁺, HER2⁻ advanced BC who progressed on ≥1 line of HT (adjuvant or advanced) and completed ≥1 line of chemotherapy (advanced). Treatment choice was evaluated for each line of therapy.

Results:

Of 355 patients, 111 (31%) received first-line chemotherapy, whereas 218 (61%) and 26 (7%) switched from HT to chemotherapy in second and third line, respectively. More patients receiving first-line HT had bone metastases (73% vs 27% chemotherapy). Patients treated with first-line chemotherapy had more brain (12% vs 3% HT) or extensive liver (13% vs 6% HT) metastases. Subgroup analysis of 188 patients who received first-line HT and had de novo advanced BC or relapsed/recurrent disease more than 1 year after adjuvant therapy found that the majority (89%; n = 167) of these patients switched to chemotherapy in second line. However, among these 167 patients, 27% had no significant changes in metastases between first and second line. Among the 73% of patients who had significant changes in metastases, 20% had no brain metastases or extensive visceral disease.

Conclusions:

Our study suggests that the guideline-recommended use of multiple HT lines is open to interpretation and that optimal treatment for European postmenopausal women with HR⁺, HER2⁻ advanced BC who responded to HT may not be achieved.

Keywords::

• Advanced breast cancer
• Chemotherapy
• Endocrine/hormone therapy
• Europe
• Guideline

Transparency

Declaration of funding

Financial support for this study and for medical editorial assistance was provided by Novartis Pharmaceuticals.

Declaration of financial/other relationships

F.A. has participated in advisory boards and speaker bureau for, and has received research funding from Novartis Pharmaceuticals Corporation. P.N. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article. N.M. has received consultancy fees from Novartis Pharmaceuticals Corporation. J.Z. is a Novartis employee and shareholder. J.-F.B. has received remuneration from and is a shareholder of Novartis Pharmaceuticals Corporation. R.D. has received consultancy fees from Novartis Pharmaceuticals Corporation. G.B. is a Novartis employee and shareholder. S.S. is a Novartis employee and shareholder. G.J. has received consultancy fees and research funding from Novartis Pharmaceuticals Corporation.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

We thank Tamalette Loh PhD, ProEd Communications Inc., for medical editorial assistance with this manuscript, which was funded by Novartis.

Previous presentations: Portions of the data were presented as posters or oral presentations at scientific congresses: André F, et al. 2012 ISPOR 15th Annual European Congress, 3–7 November 2012, Berlin, Germany, abstract PCN59 (poster); Jerusalem G, et al. 2012 ESMO Congress, 28 September–2 October 2012, Vienna, Austria, abstract 336P (poster); Jerusalem G, et al. 2013 ASCO Annual Meeting, 31 May–4 June 2013, Chicago, IL, abstract e17520 (published-only abstract).