248P - CASCADE study: pronounced decline in treatment efficacy through the metastatic life of breast cancer patients

Date 10 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Breast Cancer
Presenter Laura De Paz Arias
Citation Annals of Oncology (2016) 27 (6): 68-99. 10.1093/annonc/mdw365
Authors L. De Paz Arias1, P. García Teijido2, S. Servitja3, A. Santaballa4, J. García5, Y. Plata Fernández6, I. Garau7, J. Florian8, I. Chacón9, J. de la Haba10, P. Zamora11, L. Orcajo Rincon12, J. Rodríguez-Villanueva12, M.Á. Seguí13, E. Martínez14
  • 1Medical Oncology, Complejo Hospitalario Universitario de Ferrol, 15405 - Ferrol/ES
  • 2Medical Oncology, Hospital San Agustín de Aviles, 33401 - Avilés/ES
  • 3Medical Oncology, University Hospital del Mar, 08003 - Barcelona/ES
  • 4Medical Oncology, Hospital Universitari i Politècnic La Fe, 46026 - Valencia/ES
  • 5Medical Oncology, Complejo Hospitalario Universitario de Orense, 32005 - Ourense/ES
  • 6Medical Oncology, Complejo Hospitalario de Jaén, 23007 - Jaén/ES
  • 7Medical Oncology, Hospital Son Llatzer, 07198 - Palma de Mallorca/ES
  • 8Medical Oncology, Hospital de Barbastro, 22300 - Barbastro/ES
  • 9Medical Oncology, Hospital Virgen de la Salud, 45071 - Toledo/ES
  • 10Medical Oncology, Hospital Universitario Reina Sofía, 14004 - Cordoba/ES
  • 11Medical Oncology, Hospital Universitario La Paz, 28046 - Madrid/ES
  • 12Medical Oncology, EISAI Pharmaceuticals SA., 28033 - Madrid/ES
  • 13Medical Oncology, Hospital de Sabadell Corporacis Parc Tauli, 08208 - Sabadell/ES
  • 14Medical Oncology, Hospital Provincial Castellon, 12002 - Castellon/ES

Abstract

Background

There is scarce information regarding the actual clinical benefit current therapies have on the general population and per tumour immunotype in advanced and/or metastatic breast cancer (LA/MBC). In this regard, analysis of the response elicited per line of treatment by a given pharmacological strategy will better guide the decision-making process, thus prioritizing most active drugs in earlier lines where they might have more chances of securing a long-lasting survival impact.

Methods

13 Spanish public hospitals serving nearly 5'000'000 inhabitants (>10% of the national population) were selected. 443 patients diagnosed of LA/MBC from 01/2007 to 12/2008 were followed until death, lost to follow-up, or until December 2013. Objective response rates (ORR) and clinical benefit rates (CBR) were analysed throughout all treatment lines and per tumour immunotype. Data collected included demographical, pathological, diagnostic, and therapeutic information for each line of treatment during this time. Descriptive statistics were applied (Methods have been previously described in ESMO Congress 2015 Poster no. 1882).

Results

Important differences in both efficacy variables were seen according to treatment line and tumour immunotype. First line ORR and CBR were similar in all groups. As of the third line, however, objective responses in Triple-negative were minimal while still averaging 20% (range: 10.6% - 29.6%) for all other tumour types. HER2+ subgroups showed the overall greatest and most sustained responses (Table 1).

Immunotype Response (%) 1L 2L 3L 4L 5L 6L 7L 8L
HER2-/HR+ N = 187 ORR 40.6 10.7 21.8 11.8 8.9 14.3 10.6 16.7
CBR 72.4 56.4 50.9 46.0 31.1 39.3 36.9 33.4
Triple-negative N = 67 ORR 40.3 17.7 0.0 4.5 0.0 0.0 0.0 0.0
CBR 53.2 44.4 26.7 22.7 25.0 33.3 0.0 0.0
HER2 + /HR+ N = 72 ORR 37.9 41.3 24.3 29.6 15.8 26.7 11.1 14.3
CBR 75.8 65.2 59.4 55.5 57.9 66.7 44.4 28.6
HER2 + /HR- N = 53 ORR 49.1 38.2 30.8 20.0 0.0 16.7 0.0 0.0
CBR 68.7 73.5 69.3 55.0 30.0 33.4 0.0 33.3

ORR= complete + partial response rate. CBR= complete + partial response + disease stabilization rate.

Conclusions

There is a rapid and progressive reduction of treatment efficacy in LA/MBC, especially in those patients who do not have or have lost the benefits of hormone and anti-HER2 targeted therapies. Therefore, introduction of the most active agents should not be delayed until very late lines of treatment.

Clinical trial identification

EIS-ERI-2013-01

Legal entity responsible for the study

Eisai Pharmaceuticals SA.

Funding

Eisai Pharmaceuticals SA.

Disclosure

L. Orcajo Rincon, J. Rodríguez-Villanueva: Eisai Pharmaceuticals Employee.

All other authors have declared no conflicts of interest.