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Administration of chemotherapy for metastatic breast cancer near the end of life: A population registry study
abstracts
373P
Administration of chemotherapy for metastatic breast cancer near the end of life: A population registry study
L. Edman Kessler, J. Sigfridsson, J. Bergh, T. Foukakis, A. Matikas Oncology, Karolinska University Hospital, Stockholm, Sweden Background: The majority of patients with metastatic breast cancer (MBC) receive non-targeted cytotoxic chemotherapy during their disease trajectory. Its use however near the end of life has not been extensively studied and it’s possible that patients with advanced disease may be exposed to unnecessary aggressive treatment. Methods: Patients who were diagnosed with MBC in 2010-2015 were identified from the Stockholm-Gotland Breast Cancer Registry. Data regarding tumor characteristics, date of MBC diagnosis and death were collected from the registry. Data on chemotherapy use during the final month of the patient’s life, type of chemotherapy regimen used and albumin levels – a surrogate marker for performance status – were collected from individual patient files. Analysis of overall survival of the entire cohort was made in order to estimate contemporary survival of MBC patients. Results: In total, 1571 patients were identified. Out of 1559 patients included in the survival analysis, there were 1357 deaths and 202 patients still alive. Chemotherapy during the last month of life was given to 23.2% of the patients, more commonly to patients 60 years old (35.6% versus 18.5%, p < 0.001). A new treatment regimen was initiated in 8.4% of patients. Both albumin (OR 0.95, 95% CI 0.92 – 0.98, p ¼ 0.002) and age at the time of diagnosis (OR 1.04, 95% CI 1.02 – 1.05, p < 0.001) predicted the administration of chemotherapy. The most commonly used chemotherapeutic was capecitabine (24.8%), followed by paclitaxel (14.6%) and vinorelbine (9.8%). After a median follow-up of 73.4 months, median overall survival in the entire cohort was 16.73 months (95% CI 15.22–18.24); patients 60 years-old had better median survival compared to older ones (24.83, 95% CI 20.61-29.05 versus 13.86 months, 95% CI 12.7215.74; p < 0.001). Conclusions: Chemotherapy use near the end of life was common, especially among younger patients. Median overall survival at the population level is considerably worse as compared to results from randomized trials. This may reflect on the differences in patient characteristics and completeness of registry data, which include patients that were never treated for MBC. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J. Bergh: Research grant / Funding (institution): Merck; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): SanofiAventis; Honoraria (self): UpToDate. T. Foukakis: Honoraria (self), Research grant / Funding (institution): Roche; Honoraria (self), Research grant / Funding (institution): Pfizer; Honoraria (self): Novartis; Honoraria (self): UpToDate. All other authors have declared no conflicts of interest.
v136 | Breast Cancer, Metastatic
374P
Prognostic value of histological growth pattern in patients operated for breast cancer liver metastases
el4, P. Demetter5, D. Larsimont5, A. Bohlok1, L. Botzenhart2, V. Lucidi3, J.C. No€ V. Donckier1, P. Vermeulen6 1 Surgery, Institute Jules Bordet, Brussels, Belgium, 2Surgical Oncology, Institute Jules Bordet, Brussels, Belgium, 3Digestive Surgery, Hepatobiliary Surgery & Liver Transplantation, Erasme University Hospital-(Universite Libre de Bruxelles), Brussels, Belgium, 4Pathology, Erasme University Hospital-(Universite Libre de Bruxelles), Brussels, Belgium, 5Pathology, Institut Jules Bordet, Brussels, Belgium, 6Center for Oncological Research, University of Antwerp, Antwerp, Belgium Background: Surgery for breast cancer liver metastases (BCLM) remains controversial. Recently, histological growth pattern (HGP), defined as replacement (rHGP) or desmoplastic (dHGP), has been demonstrated of prognostic value in patients operated for colorectal liver metastases. In BCLM, the types of HGP and their prognostic values have not been determined. We aimed to characterize HGPs in a series of patients undergoing liver resection for BCLM and correlate these patterns with postoperative outcomes. Methods: A series of 74 patients operated for BCLM was reviewed. Clinicopathologic variables, overall and disease-free survivals (OS and DFS) were analyzed. HGP could not be evaluated in 37 cases, due to exclusive radiofrequency treatment (N ¼ 22), complete pathological response (N ¼ 9) or unavailability of tissue sections (N ¼ 6). HGP was assessed in archival H&E stained tissue sections, according to international consensus guidelines in 37 patients. The proportions of rHGP and dHGP were determined in each metastasis. Patients were categorized as pure (100% rHGP or dHGP) or dominant phenotype (>50% rHGP or dHGP, on the entire tumor/normal liver interface). In case of multiple metastases, mean HGP was calculated. All these factors were correlated with OS and DFS. Results: After a mean postoperative follow-up of 81 months, 5-years OS and DFS in global population were 49.7% and 22.7%, respectively. No clinicopathologic preoperative factor was found to be predictive for OS or DFS. Among the 37 patients analyzed for HGP, 17 were pure rHGP (46%), 10 dominant rHGP (27%), 9 dominant dHGP (24.3%) and 1 pure dHGP. Five-years OS and DFS were significantly reduced in patients with pure rHGP, respectively of 20.3 and 0% (all patients recurring within 2 years) as compared with patients with any dHGP component, respectively of 63 and 45% (p ¼ 0.03 and <0.003). No other parameter (patient, primary tumor and BCLM characteristics) was significantly different between the patients with pure rHGP and those with any dHGP component. Conclusions: In this series of patients undergoing surgical resection for BCLM, the large majority of metastases displayed pure or dominant rHGP. Pure rHGP appears as a strong negative prognostic factor for postoperative outcome in these patients. Legal entity responsible for the study: Vincent Donckier. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
375P
Illness perceptions, quality of life and mood in metastatic breast cancer patients
I. Domingues, J. Carvalho, E.A. Pratas, S. Pinheiro, S. Amaral, T. Pereira, F. Pontes, R. Fe´lix, A. Chaves, M. Mariano, T. Carvalho, P. Madeira, A. P^ ego, S. Broco, R. Garcia, I. Pazos, A. Pais, G. Sousa Medical Oncology, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal Background: The patients’ (pts) illness perception is based on dimensions of cognitive understanding and emotional representations of disease and its symptoms. Previous studies reported that illness perceptions influence quality of life (QoL) and mood. Methods: 212 pts with metastatic breast cancer, under treatment, were evaluated by Illness Perception Questionnaire Brief version (IPQ-B), EORTC Quality of Life Questionnaire (QLQ-30) and Hospital Anxiety and Depression Scale (HADS). IPQ-B higher scores indicate a negative perception. EORTC QLQ-30 higher scores indicate better functioning/QoL or worse symptom severity. Higher HADS indicate higher anxiety/depression (AD) levels. Variables were studied using Pearls correlation (Sig 0.01) and T test. Primary endpoint was evaluation of illness perception. Secondary endpoints were assessment of pts characteristics, QoL, AD and its associations with illness perception. Results: Median age was 64 years (y) and 99.5% (211 pts) were women. Median IPQ-B score was 18/32. All patients reported that their breast cancer is incurable. Perception of disease consequences was more negative in pts younger than 70y versus 70y or older (2.7 vs 2.3, p ¼ 0.039). Preoccupation and perception of control with treatment were higher in younger pts (3.4 vs 2.9, p ¼ 0.004; 3.6 vs 3.3, p ¼ 0.03; respectively). Pts under chemotherapy and/or anti-HER2 therapy shown a greater impact of disease consequences, than pts under endocrine therapy and/or other target therapies (2.6 vs 2.3, p ¼ 0.039). The mean overall QoL was 54.6/100 (6 23.0). Physical, cognitive, social and emotional functioning mean scores were respectively 60.3, 69.1, 69.3 and 60.3/100; all lower than EORTC ref. values (p < 0.01). Social functioning and IPQ-B shown a moderate negative correlation (r ¼ - 0.507). The mean HADS score was 16.9/42 (6 7.8), reflecting the AD subscales (respectively, 9.1/21; 7.8/21). The overall illness perception and HADS shown a moderate positive association (r ¼ 0.62). Anxiety and the emotional dimension of IPQ-B had a moderate positive correlation (r ¼ 0.598).
Volume 30 | Supplement 5 | October 2019
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hormone receptor (HR)þHER2-, HRþ/HER2þ, HR-/HER2þ, and triple negative BC (TNBC). Results: The median age at the time of diagnosis with LM was 49 years (range 30–69 years). Isolated central nervous system (CNS) metastasis was observed in 37.1% (26/ 70) of patients, and more than half of the patients (47/70, 67.1%) received whole brain radiotherapy (WBRT) before and/or after VPS. The median overall survival (OS) after CNS metastasis was significantly longer in HR-/HER2þ patients (16.2 months, 95% confidence interval, CI 13.7–18.6, p ¼ 0.009), and anti-HER2 treatment was identified as a significant prognostic factor for better OS based on multivariate analysis (hazard ratio, HR 0.15, 95% CI 0.04–0.57, p ¼ 0.005). TNBC was correlated with shorter OS after CNS metastasis (HR 2.82, 95% CI 1.46–5.48, p ¼ 0.002). The median OS after VPS was 2.3 months (95% CI 1.8–2.7) in all patients, and 6-months OS rates after VPS were 0% and 3.9% in HR-HER2þ and in TNBC, respectively. Conclusions: The clinical outcome of BC patients after CNS metastasis who received VPS was significantly different in real-world clinical setting based on intrinsic subtype. Anti-HER2 treatment should be attempted after CNS metastasis in HER2þ patients. However, the survival of metastatic BC (MBC) after VPS remains poor, especially in HR-/HER2þ and TNBC subgroups. Further investigations are required to improve the prognosis of LM. Legal entity responsible for the study: Yeon Hee Park. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
373P
Administration of chemotherapy for metastatic breast cancer near the end of life: A population registry study
L. Edman Kessler, J. Sigfridsson, J. Bergh, T. Foukakis, A. Matikas Oncology, Karolinska University Hospital, Stockholm, Sweden Background: The majority of patients with metastatic breast cancer (MBC) receive non-targeted cytotoxic chemotherapy during their disease trajectory. Its use however near the end of life has not been extensively studied and it’s possible that patients with advanced disease may be exposed to unnecessary aggressive treatment. Methods: Patients who were diagnosed with MBC in 2010-2015 were identified from the Stockholm-Gotland Breast Cancer Registry. Data regarding tumor characteristics, date of MBC diagnosis and death were collected from the registry. Data on chemotherapy use during the final month of the patient’s life, type of chemotherapy regimen used and albumin levels – a surrogate marker for performance status – were collected from individual patient files. Analysis of overall survival of the entire cohort was made in order to estimate contemporary survival of MBC patients. Results: In total, 1571 patients were identified. Out of 1559 patients included in the survival analysis, there were 1357 deaths and 202 patients still alive. Chemotherapy during the last month of life was given to 23.2% of the patients, more commonly to patients 60 years old (35.6% versus 18.5%, p < 0.001). A new treatment regimen was initiated in 8.4% of patients. Both albumin (OR 0.95, 95% CI 0.92 – 0.98, p ¼ 0.002) and age at the time of diagnosis (OR 1.04, 95% CI 1.02 – 1.05, p < 0.001) predicted the administration of chemotherapy. The most commonly used chemotherapeutic was capecitabine (24.8%), followed by paclitaxel (14.6%) and vinorelbine (9.8%). After a median follow-up of 73.4 months, median overall survival in the entire cohort was 16.73 months (95% CI 15.22–18.24); patients 60 years-old had better median survival compared to older ones (24.83, 95% CI 20.61-29.05 versus 13.86 months, 95% CI 12.7215.74; p < 0.001). Conclusions: Chemotherapy use near the end of life was common, especially among younger patients. Median overall survival at the population level is considerably worse as compared to results from randomized trials. This may reflect on the differences in patient characteristics and completeness of registry data, which include patients that were never treated for MBC. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J. Bergh: Research grant / Funding (institution): Merck; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): SanofiAventis; Honoraria (self): UpToDate. T. Foukakis: Honoraria (self), Research grant / Funding (institution): Roche; Honoraria (self), Research grant / Funding (institution): Pfizer; Honoraria (self): Novartis; Honoraria (self): UpToDate. All other authors have declared no conflicts of interest.
v136 | Breast Cancer, Metastatic
374P
Prognostic value of histological growth pattern in patients operated for breast cancer liver metastases
el4, P. Demetter5, D. Larsimont5, A. Bohlok1, L. Botzenhart2, V. Lucidi3, J.C. No€ V. Donckier1, P. Vermeulen6 1 Surgery, Institute Jules Bordet, Brussels, Belgium, 2Surgical Oncology, Institute Jules Bordet, Brussels, Belgium, 3Digestive Surgery, Hepatobiliary Surgery & Liver Transplantation, Erasme University Hospital-(Universite Libre de Bruxelles), Brussels, Belgium, 4Pathology, Erasme University Hospital-(Universite Libre de Bruxelles), Brussels, Belgium, 5Pathology, Institut Jules Bordet, Brussels, Belgium, 6Center for Oncological Research, University of Antwerp, Antwerp, Belgium Background: Surgery for breast cancer liver metastases (BCLM) remains controversial. Recently, histological growth pattern (HGP), defined as replacement (rHGP) or desmoplastic (dHGP), has been demonstrated of prognostic value in patients operated for colorectal liver metastases. In BCLM, the types of HGP and their prognostic values have not been determined. We aimed to characterize HGPs in a series of patients undergoing liver resection for BCLM and correlate these patterns with postoperative outcomes. Methods: A series of 74 patients operated for BCLM was reviewed. Clinicopathologic variables, overall and disease-free survivals (OS and DFS) were analyzed. HGP could not be evaluated in 37 cases, due to exclusive radiofrequency treatment (N ¼ 22), complete pathological response (N ¼ 9) or unavailability of tissue sections (N ¼ 6). HGP was assessed in archival H&E stained tissue sections, according to international consensus guidelines in 37 patients. The proportions of rHGP and dHGP were determined in each metastasis. Patients were categorized as pure (100% rHGP or dHGP) or dominant phenotype (>50% rHGP or dHGP, on the entire tumor/normal liver interface). In case of multiple metastases, mean HGP was calculated. All these factors were correlated with OS and DFS. Results: After a mean postoperative follow-up of 81 months, 5-years OS and DFS in global population were 49.7% and 22.7%, respectively. No clinicopathologic preoperative factor was found to be predictive for OS or DFS. Among the 37 patients analyzed for HGP, 17 were pure rHGP (46%), 10 dominant rHGP (27%), 9 dominant dHGP (24.3%) and 1 pure dHGP. Five-years OS and DFS were significantly reduced in patients with pure rHGP, respectively of 20.3 and 0% (all patients recurring within 2 years) as compared with patients with any dHGP component, respectively of 63 and 45% (p ¼ 0.03 and <0.003). No other parameter (patient, primary tumor and BCLM characteristics) was significantly different between the patients with pure rHGP and those with any dHGP component. Conclusions: In this series of patients undergoing surgical resection for BCLM, the large majority of metastases displayed pure or dominant rHGP. Pure rHGP appears as a strong negative prognostic factor for postoperative outcome in these patients. Legal entity responsible for the study: Vincent Donckier. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
375P
Illness perceptions, quality of life and mood in metastatic breast cancer patients
I. Domingues, J. Carvalho, E.A. Pratas, S. Pinheiro, S. Amaral, T. Pereira, F. Pontes, R. Fe´lix, A. Chaves, M. Mariano, T. Carvalho, P. Madeira, A. P^ ego, S. Broco, R. Garcia, I. Pazos, A. Pais, G. Sousa Medical Oncology, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal Background: The patients’ (pts) illness perception is based on dimensions of cognitive understanding and emotional representations of disease and its symptoms. Previous studies reported that illness perceptions influence quality of life (QoL) and mood. Methods: 212 pts with metastatic breast cancer, under treatment, were evaluated by Illness Perception Questionnaire Brief version (IPQ-B), EORTC Quality of Life Questionnaire (QLQ-30) and Hospital Anxiety and Depression Scale (HADS). IPQ-B higher scores indicate a negative perception. EORTC QLQ-30 higher scores indicate better functioning/QoL or worse symptom severity. Higher HADS indicate higher anxiety/depression (AD) levels. Variables were studied using Pearls correlation (Sig 0.01) and T test. Primary endpoint was evaluation of illness perception. Secondary endpoints were assessment of pts characteristics, QoL, AD and its associations with illness perception. Results: Median age was 64 years (y) and 99.5% (211 pts) were women. Median IPQ-B score was 18/32. All patients reported that their breast cancer is incurable. Perception of disease consequences was more negative in pts younger than 70y versus 70y or older (2.7 vs 2.3, p ¼ 0.039). Preoccupation and perception of control with treatment were higher in younger pts (3.4 vs 2.9, p ¼ 0.004; 3.6 vs 3.3, p ¼ 0.03; respectively). Pts under chemotherapy and/or anti-HER2 therapy shown a greater impact of disease consequences, than pts under endocrine therapy and/or other target therapies (2.6 vs 2.3, p ¼ 0.039). The mean overall QoL was 54.6/100 (6 23.0). Physical, cognitive, social and emotional functioning mean scores were respectively 60.3, 69.1, 69.3 and 60.3/100; all lower than EORTC ref. values (p < 0.01). Social functioning and IPQ-B shown a moderate negative correlation (r ¼ - 0.507). The mean HADS score was 16.9/42 (6 7.8), reflecting the AD subscales (respectively, 9.1/21; 7.8/21). The overall illness perception and HADS shown a moderate positive association (r ¼ 0.62). Anxiety and the emotional dimension of IPQ-B had a moderate positive correlation (r ¼ 0.598).
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz242.068/5577447 by guest on 25 October 2019
hormone receptor (HR)þHER2-, HRþ/HER2þ, HR-/HER2þ, and triple negative BC (TNBC). Results: The median age at the time of diagnosis with LM was 49 years (range 30–69 years). Isolated central nervous system (CNS) metastasis was observed in 37.1% (26/ 70) of patients, and more than half of the patients (47/70, 67.1%) received whole brain radiotherapy (WBRT) before and/or after VPS. The median overall survival (OS) after CNS metastasis was significantly longer in HR-/HER2þ patients (16.2 months, 95% confidence interval, CI 13.7–18.6, p ¼ 0.009), and anti-HER2 treatment was identified as a significant prognostic factor for better OS based on multivariate analysis (hazard ratio, HR 0.15, 95% CI 0.04–0.57, p ¼ 0.005). TNBC was correlated with shorter OS after CNS metastasis (HR 2.82, 95% CI 1.46–5.48, p ¼ 0.002). The median OS after VPS was 2.3 months (95% CI 1.8–2.7) in all patients, and 6-months OS rates after VPS were 0% and 3.9% in HR-HER2þ and in TNBC, respectively. Conclusions: The clinical outcome of BC patients after CNS metastasis who received VPS was significantly different in real-world clinical setting based on intrinsic subtype. Anti-HER2 treatment should be attempted after CNS metastasis in HER2þ patients. However, the survival of metastatic BC (MBC) after VPS remains poor, especially in HR-/HER2þ and TNBC subgroups. Further investigations are required to improve the prognosis of LM. Legal entity responsible for the study: Yeon Hee Park. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology