- Email: [email protected]
Real-world treatment sequencing patterns in secondary breast cancer (SBC): Pathway visualisation using national datasets
abstracts
Annals of Oncology Conclusions: Integrating in clinical practice the relation between illness perceptions, QoL and AD, may improve disease’s coping mechanisms and functional capacity (physical, emotional, social). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
376P
J. Zhang, M. Li, H. Gong Radiotherapy, Shandong Tumor Hospital, Jinan, China Background: Primary treatments for stage IV breast cancer are chemotherapy and endocrine therapy. We sought to determine whether multidisciplinary therapy provides a survival advantage for women with metastatic breast cancer. Methods: We conducted a population-based cohort study by using the 2010-2014 Surveillance, Epidemiology, and End Results (SEER) program data. By use of the logrank test and multivariate cox regression models, overall survival in patients was compared between women who underwent different combination modes of surgery, radiotherapy and chemotherapy, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores. Results: Of 17191 SEER patients with de novo stage IV breast cancer, 29.4% underwent surgery, 32.3% received radiotherapy and 49.6% received chemotherapy. The median follow-up was 28.0 months for all patients. The median survival time of combined surgery, chemotherapy and radiotherapy(SCRT), combined surgery and radiotherapy(SRT),combined surgery and chemotherapy(SC), combined chemotherapy and radiotherapy (CRT), surgery alone, chemotherapy alone, radiotherapy alone and no therapy were 51.0m (95%CI, NR), 46m (95%CI, 39.7-52.3), 37.0m (95%CI, 33.4-40.6), 22.0m (95%CI, 20.0-24.0), 29.0m (95%CI, 25.3-32.7), 26.0m (95%CI, 24.527.5), 22.0m (95%CI, 19.9-24.1) and 13.0m (95%CI, 11.8-14.2), respectively (p<0.001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery, radiotherapy and chemotherapy were less likely to die compared with patients who did not undergo surgery, radiotherapy and chemotherapy,respectively (HR ¼ 0.32, 95% CI, 0.30-0.34, p<0.001, HR ¼ 0.40, 95%CI, 0.38-0.43, p<0.001 and HR ¼ 0.51, 95%CI, 0.48-0.54, p<0.001). There was no statistically significant difference among patients with different breast cancer subtype. Conclusions: Analysis of 2010-2014 SEER data indicated that multidisciplinary approach is especially important in the management of newly diagnosed metastatic breast cancer to consider all potential treatment options for optimal outcomes. Legal entity responsible for the study: Jian Zhang. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
378P
A.W.B. Horne1, M. McMenemy2, E. Holly3, N. Rigglesford2, P. Linksted4, L. Murdoch3, O. Oikonomidou5, C. Michie1, L. Hayward1, C. Lilley1, P. Hall6 1 Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK, 2Lothian Analytical Services, NHS Lothian, Edinburgh, UK, 3Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK, 4Research & Development, NHS Lothian, Edinburgh, UK, 5Oncology, Edinburgh Cancer Centre Western General Hospital, Edinburgh, UK, 6Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK Background: Treatment pathways in metastatic breast cancer are complex. The accelerated adoption of new medicines has resulted in an uncertain evidence base supporting their use. Uncertainties are related to the mismatch between trial-recruited and realworld populations and variation in the order of sequential drugs. Published examples describing real-world practice in SBC are scarce, mainly due to the complexity of the clinical pathways that rely on a mixture of chemotherapy, endocrine therapy and biologicals, often over a long period. We demonstrate how new opportunities in routine healthcare data allow a highly granular description of real-world treatment pathways and how this varies in light of patient (pt) case-mix. Methods: Scottish nationally available data source datasets for linkage included the National Cancer Registry, Scottish Morbidity Record, the National Cancer Quality Audit and the national Prescribing Information System. Scottish CHI number was the universal identifier for linkage. Key baseline characteristics included age, de-novo presentation, prior adjuvant treatments, co-morbidities, concomitant medications and socioeconomic status. Targeted and random sampling manual review was used to quantify missing data. R version 3.6 was used for analysis. Results: 345 pts were identified of which 276 had ERþHER2- SBC between 2012-2017. First line therapy included 68% (235 patients) endocrine therapy, 17% (59 pts) chemotherapy, 14% (50 pts) received no treatment. Subsequent treatment decisions, including best supportive care and death, have been tracked to identify 70 unique pathways with up to 8 lines of treatment. Graphical representation of treatment pathways is made using Sankey plots. Detailed data quality reports describe missing data rates over time and a comprehensive guide for analysts has been produced as a wiki [https://blogs. ed.ac.uk/canceroutcomes/edinburgh-cancer-informatics-wiki/]. Conclusions: It is now possible to describe treatment sequences using routine, nationally available administrative healthcare data. Pathways are complex and do not always conform to standard guidelines. Interpretation requires modern graphical visualisation methods. Legal entity responsible for the study: NHS Lothian and the University of Edinburgh. Funding: NHS Lothian and. Disclosure: All authors have declared no conflicts of interest.
379P 377P
Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping
J. Zhang Breast Cancer Department, Tianjin Cancer Hospital, Tianjin, China Background: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. Methods: A retrospective analysis of 327 patients aged 65 years with stage I-II, hormone receptor positive breast cancer who underwent breast conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ETþRT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR). Results: There were significant differences in 5-year DFS (HR 1.59, 95% CI 1.15–2.19, P ¼ 0.005) and LRR (HR 3.33, 95% CI 1.51–7.34, P ¼ 0.003), whereas there were no significant differences in OS and DMR between the two groups. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS, and DMR between the ET group and the ETþRT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR 2.188, 95% CI 1.37–3.49, P ¼ 0.001), LRR (HR 5.447, 95% CI 1.65– 17.98, P ¼ 0.005), and OS (HR 1.752, 95% CI 1.01–3.054, P ¼ 0.048) between the two groups. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR 1.841, 95% CI 1.23–2.75, P ¼ 0.003) and OS (HR 1.763, 95% CI 1.07–2.91, P ¼ 0.026). Conclusions: After breast conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients. Legal entity responsible for the study: The author. Funding: National Natural Science Foundation of China (81672623).
Volume 30 | Supplement 5 | October 2019
Real-world treatment sequencing patterns in secondary breast cancer (SBC): Pathway visualisation using national datasets
Utilization pattern of bone targeting agents in patients with solid tumour in Taiwan, Hong Kong and Korea
S.J.J. Lai1, P.C.M. Au2, Y.H. Baek3, C.L. Cheung2, S.N. Gao4, Y.H. Kao Yang1, N. Kleinman4, J.H. Kim3, J. Lange5, T.C. Liao1, T.C. Lin5, K.K. Man2, J.Y. Shin3, C.W. Sing2, I.C.K. Wong2, E.C.C. Lai1 1 School of Pharmacy, Institute Of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan City, Taiwan, 2Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China, 3School of Pharmacy, SungKyunKwan University (SKKU), Seoul, Republic of Korea, 4Clinical Development, Amgen Asia Holding Limited, Hong Kong, China, 5 Clinical Development, Amgen Inc., Thousand Oaks, CA, USA Background: Bone targeting agents (BTA) are prescribed for the prevention of skeletalrelated events in patients with bone metastases from solid tumors. The use of BTA varies by region and little is known about use in Asia. This study evaluated the utilization patterns of BTA in patients within Taiwan, Hong Kong, and Korea. Methods: This retrospective cohort study included patients diagnosed with a solid tumor (breast, prostate, or lung cancer) and with receipt of a BTA (intravenous zoledronate, pamidronate, or denosumab). All records were retrieved from databases including: the Taiwan National Health Insurance Database (NHID) of years 2012-2017, Korea’s NHID of years 2012-2016, and Hong Kong’s Clinical Data Analysis and Reporting System (CDARS) of years 2012-2017. Descriptive analyses were conducted to describe patient characteristics, the rate of BTA use among patients with a solid tumor by year and duration of BTA use in Taiwan, Hong Kong and Korea. Results: We identified 18,286 (54% male), 2,861 (48% male) and 12,803 (41% male) patients with a solid tumor and BTA receipt in Taiwan, Hong Kong, and Korea, respectively. The mean age at BTA recipient was 64.1 (SD 13.7) in Taiwan, 64.3 (SD 12.8) in Hong Kong, and 61.5 (SD 12.9) in Korea. For patients with BTA use, the predominant tumor type was breast cancer in Taiwan (41%) and Korea (50%), and was lung cancer (53%) in Hong Kong. For the entire study period, the rates of BTA use among solid tumor patients were 8.3% in Taiwan, 5.9% in Hong Kong and 3.1% in Korea. The rates of BTA use increased gradually during study period in each place. In year 2016, the
doi:10.1093/annonc/mdz242 | v137
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz242.073/5577485 by guest on 24 October 2019
Multidisciplinary treatments increase overall survival in patients with newly diagnosed stage IV breast cancer: An analysis of 2010–2014 SEER data
Disclosure: The author has declared no conflicts of interest.
Annals of Oncology Conclusions: Integrating in clinical practice the relation between illness perceptions, QoL and AD, may improve disease’s coping mechanisms and functional capacity (physical, emotional, social). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
376P
J. Zhang, M. Li, H. Gong Radiotherapy, Shandong Tumor Hospital, Jinan, China Background: Primary treatments for stage IV breast cancer are chemotherapy and endocrine therapy. We sought to determine whether multidisciplinary therapy provides a survival advantage for women with metastatic breast cancer. Methods: We conducted a population-based cohort study by using the 2010-2014 Surveillance, Epidemiology, and End Results (SEER) program data. By use of the logrank test and multivariate cox regression models, overall survival in patients was compared between women who underwent different combination modes of surgery, radiotherapy and chemotherapy, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores. Results: Of 17191 SEER patients with de novo stage IV breast cancer, 29.4% underwent surgery, 32.3% received radiotherapy and 49.6% received chemotherapy. The median follow-up was 28.0 months for all patients. The median survival time of combined surgery, chemotherapy and radiotherapy(SCRT), combined surgery and radiotherapy(SRT),combined surgery and chemotherapy(SC), combined chemotherapy and radiotherapy (CRT), surgery alone, chemotherapy alone, radiotherapy alone and no therapy were 51.0m (95%CI, NR), 46m (95%CI, 39.7-52.3), 37.0m (95%CI, 33.4-40.6), 22.0m (95%CI, 20.0-24.0), 29.0m (95%CI, 25.3-32.7), 26.0m (95%CI, 24.527.5), 22.0m (95%CI, 19.9-24.1) and 13.0m (95%CI, 11.8-14.2), respectively (p<0.001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery, radiotherapy and chemotherapy were less likely to die compared with patients who did not undergo surgery, radiotherapy and chemotherapy,respectively (HR ¼ 0.32, 95% CI, 0.30-0.34, p<0.001, HR ¼ 0.40, 95%CI, 0.38-0.43, p<0.001 and HR ¼ 0.51, 95%CI, 0.48-0.54, p<0.001). There was no statistically significant difference among patients with different breast cancer subtype. Conclusions: Analysis of 2010-2014 SEER data indicated that multidisciplinary approach is especially important in the management of newly diagnosed metastatic breast cancer to consider all potential treatment options for optimal outcomes. Legal entity responsible for the study: Jian Zhang. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
378P
A.W.B. Horne1, M. McMenemy2, E. Holly3, N. Rigglesford2, P. Linksted4, L. Murdoch3, O. Oikonomidou5, C. Michie1, L. Hayward1, C. Lilley1, P. Hall6 1 Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK, 2Lothian Analytical Services, NHS Lothian, Edinburgh, UK, 3Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK, 4Research & Development, NHS Lothian, Edinburgh, UK, 5Oncology, Edinburgh Cancer Centre Western General Hospital, Edinburgh, UK, 6Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK Background: Treatment pathways in metastatic breast cancer are complex. The accelerated adoption of new medicines has resulted in an uncertain evidence base supporting their use. Uncertainties are related to the mismatch between trial-recruited and realworld populations and variation in the order of sequential drugs. Published examples describing real-world practice in SBC are scarce, mainly due to the complexity of the clinical pathways that rely on a mixture of chemotherapy, endocrine therapy and biologicals, often over a long period. We demonstrate how new opportunities in routine healthcare data allow a highly granular description of real-world treatment pathways and how this varies in light of patient (pt) case-mix. Methods: Scottish nationally available data source datasets for linkage included the National Cancer Registry, Scottish Morbidity Record, the National Cancer Quality Audit and the national Prescribing Information System. Scottish CHI number was the universal identifier for linkage. Key baseline characteristics included age, de-novo presentation, prior adjuvant treatments, co-morbidities, concomitant medications and socioeconomic status. Targeted and random sampling manual review was used to quantify missing data. R version 3.6 was used for analysis. Results: 345 pts were identified of which 276 had ERþHER2- SBC between 2012-2017. First line therapy included 68% (235 patients) endocrine therapy, 17% (59 pts) chemotherapy, 14% (50 pts) received no treatment. Subsequent treatment decisions, including best supportive care and death, have been tracked to identify 70 unique pathways with up to 8 lines of treatment. Graphical representation of treatment pathways is made using Sankey plots. Detailed data quality reports describe missing data rates over time and a comprehensive guide for analysts has been produced as a wiki [https://blogs. ed.ac.uk/canceroutcomes/edinburgh-cancer-informatics-wiki/]. Conclusions: It is now possible to describe treatment sequences using routine, nationally available administrative healthcare data. Pathways are complex and do not always conform to standard guidelines. Interpretation requires modern graphical visualisation methods. Legal entity responsible for the study: NHS Lothian and the University of Edinburgh. Funding: NHS Lothian and. Disclosure: All authors have declared no conflicts of interest.
379P 377P
Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping
J. Zhang Breast Cancer Department, Tianjin Cancer Hospital, Tianjin, China Background: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. Methods: A retrospective analysis of 327 patients aged 65 years with stage I-II, hormone receptor positive breast cancer who underwent breast conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ETþRT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR). Results: There were significant differences in 5-year DFS (HR 1.59, 95% CI 1.15–2.19, P ¼ 0.005) and LRR (HR 3.33, 95% CI 1.51–7.34, P ¼ 0.003), whereas there were no significant differences in OS and DMR between the two groups. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS, and DMR between the ET group and the ETþRT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR 2.188, 95% CI 1.37–3.49, P ¼ 0.001), LRR (HR 5.447, 95% CI 1.65– 17.98, P ¼ 0.005), and OS (HR 1.752, 95% CI 1.01–3.054, P ¼ 0.048) between the two groups. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR 1.841, 95% CI 1.23–2.75, P ¼ 0.003) and OS (HR 1.763, 95% CI 1.07–2.91, P ¼ 0.026). Conclusions: After breast conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients. Legal entity responsible for the study: The author. Funding: National Natural Science Foundation of China (81672623).
Volume 30 | Supplement 5 | October 2019
Real-world treatment sequencing patterns in secondary breast cancer (SBC): Pathway visualisation using national datasets
Utilization pattern of bone targeting agents in patients with solid tumour in Taiwan, Hong Kong and Korea
S.J.J. Lai1, P.C.M. Au2, Y.H. Baek3, C.L. Cheung2, S.N. Gao4, Y.H. Kao Yang1, N. Kleinman4, J.H. Kim3, J. Lange5, T.C. Liao1, T.C. Lin5, K.K. Man2, J.Y. Shin3, C.W. Sing2, I.C.K. Wong2, E.C.C. Lai1 1 School of Pharmacy, Institute Of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan City, Taiwan, 2Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China, 3School of Pharmacy, SungKyunKwan University (SKKU), Seoul, Republic of Korea, 4Clinical Development, Amgen Asia Holding Limited, Hong Kong, China, 5 Clinical Development, Amgen Inc., Thousand Oaks, CA, USA Background: Bone targeting agents (BTA) are prescribed for the prevention of skeletalrelated events in patients with bone metastases from solid tumors. The use of BTA varies by region and little is known about use in Asia. This study evaluated the utilization patterns of BTA in patients within Taiwan, Hong Kong, and Korea. Methods: This retrospective cohort study included patients diagnosed with a solid tumor (breast, prostate, or lung cancer) and with receipt of a BTA (intravenous zoledronate, pamidronate, or denosumab). All records were retrieved from databases including: the Taiwan National Health Insurance Database (NHID) of years 2012-2017, Korea’s NHID of years 2012-2016, and Hong Kong’s Clinical Data Analysis and Reporting System (CDARS) of years 2012-2017. Descriptive analyses were conducted to describe patient characteristics, the rate of BTA use among patients with a solid tumor by year and duration of BTA use in Taiwan, Hong Kong and Korea. Results: We identified 18,286 (54% male), 2,861 (48% male) and 12,803 (41% male) patients with a solid tumor and BTA receipt in Taiwan, Hong Kong, and Korea, respectively. The mean age at BTA recipient was 64.1 (SD 13.7) in Taiwan, 64.3 (SD 12.8) in Hong Kong, and 61.5 (SD 12.9) in Korea. For patients with BTA use, the predominant tumor type was breast cancer in Taiwan (41%) and Korea (50%), and was lung cancer (53%) in Hong Kong. For the entire study period, the rates of BTA use among solid tumor patients were 8.3% in Taiwan, 5.9% in Hong Kong and 3.1% in Korea. The rates of BTA use increased gradually during study period in each place. In year 2016, the
doi:10.1093/annonc/mdz242 | v137
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz242.073/5577485 by guest on 24 October 2019
Multidisciplinary treatments increase overall survival in patients with newly diagnosed stage IV breast cancer: An analysis of 2010–2014 SEER data
Disclosure: The author has declared no conflicts of interest.