Abstract 250P
Background
Immune-checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase inhibitors (PARPi) have improved efficacy in clinical trials and expanded the tx options in pts with previously untreated mTNBC. Evolving tx options for early TNBC have decreased relapse rates and improved survival. This study aims to describe how changes in the tx landscape translate into the rw setting in the United States.
Methods
This retrospective observational study used Flatiron Health electronic health record data. Adult pts initiating first-line (1L) tx for mTNBC (Jan 2011-May 2022) were included. A stratified analysis by period of mTNBC diagnosis was conducted before (2011-2017, early cohort) and after (2018-2022, late cohort) approval of PARPi and ICIs. Pt characteristics, tx received, and outcomes (rw overall survival [rwOS]; time to next tx or death [TTNTD]) were described for each cohort.
Results
Of the 2004 pts who initiated 1L tx, 53% and 47% were diagnosed with mTNBC before and after 2018, respectively. Most were treated in community settings as expected (early: 89%; late: 83%). The proportion of pts with obesity (early: 34%; late: 38%), aged ≥ 65 years (early: 34%; late: 43%), and with de novo mTNBC (early: 27%; late: 33%) increased over time. In the early cohort, 97% of pts were treated with chemotherapy (CT; single-agent: 53%; combination: 44%). From 2019, ICI use increased to 33% on average and CT use decreased to 65% (single-agent: 40%; combination: 25%); PARPi use was < 2%. Median rwOS [95% CI] and median TTNTD were comparable between cohorts (early: 10.9 mo [10.3-11.6]; late: 11.9 mo [10.7-13.1] and early: 4.4 mo [4.1-4.8]; late: 4.2 mo [3.8- 4.5], respectively). Of the pts with 1L tx, 53% and 50% subsequently received second-line (2L) tx in the early and late cohorts, respectively; 40% and 34% did not survive.
Conclusions
This rw analysis confirms the poor prognosis of previously untreated mTNBC. Despite introduction of ICIs and PARPi, rwOS and TTNTD were comparable before and after 2018. Attrition rates between 1L and 2L treatment remain high. These data demonstrate the unmet need for more efficacious treatments in 1L mTNBC.
Editorial acknowledgement
Editorial support was provided by Catherine Bowe, PhD, of Parexel International and funded by Gilead Sciences, Inc.
Legal entity responsible for the study
Gilead Sciences, Inc.
Funding
Gilead Sciences, Inc.
Disclosure
K. Punie: Financial Interests, Institutional, Advisory Board: AstraZeneca, Novartis, Roche, Vifor Pharma, Eli Lilly, Pierre Fabre, McCann Health, Roularta, Teva, Gilead Sciences, Pfizer, Gilead, MSD; Financial Interests, Institutional, Invited Speaker: Pfizer, Roche, Novartis, Eli Lilly, Mundi Pharma, MSD, Medscape; Financial Interests, Institutional, Other, Consultancy: Roche; Financial Interests, Personal, Other, Consultancy: Gilead, Novartis, MSD, Roche; Financial Interests, Personal, Invited Speaker: Sanofi, AstraZeneca, Exact Sciences, Focus Patient, Pfizer, Gilead Sciences, Eli Lilly, Eli Lilly, Medimix; Financial Interests, Personal, Advisory Board: Seagen, AstraZeneca, Pfizer; Financial Interests, Institutional, Funding: Sanofi; Non-Financial Interests, Leadership Role, Vice President: Belgian Society of Medical Oncology BSMO; Non-Financial Interests, Other, Committee Member: ESMO Resilience Task Force; Non-Financial Interests, Leadership Role: EORTC Breast Cancer Task Force Steering Committee Member; Non-Financial Interests, Advisory Role: Commission personalized medecine Federal Government Belgium; Non-Financial Interests, Advisory Role, External Scientific Advisor: European Medicine Agency. I. Ntalla: Financial Interests, Personal, Full or part-time Employment: Gilead Sciences; Financial Interests, Personal, Stocks/Shares: Gilead Sciences. C. Lai: Financial Interests, Personal, Full or part-time Employment: Gilead Sciences; Financial Interests, Personal, Stocks/Shares: Roche, Gilead Sciences. S.A. Hurvitz: Financial Interests, Personal, Invited Speaker: Clinical Care Options, axis medical, cancer expert now, ICHE, MJH Associates, PER, Primo, Projects in Knowledge, Prova Education, Research to Practice, Ultimate Medical Academy, Vaniam, WebMD, Peer Education, PrecisCA, Peer Voice, Curio, Reach MD/MedIQ, Imedex, MD Outlook, Prime Oncology, Reach MD, OncLive; Financial Interests, Personal, Stocks/Shares, spouse owns: ROM Tech; Financial Interests, Personal, Royalties, author medical book: McGraw; Financial Interests, Personal, Royalties: Elsevier, Springer, Sage, Wolters Kluwer, Wiley; Financial Interests, Institutional, Invited Speaker: Ambrx, AstraZeneca, Arvinas, Daiichi Sankyo, Genentech/Roche, Gilead, GSK, Immunomedics, Eli Lilly, Macrogenics, Novartis, Pfizer, OBI Pharma, Pieris, PUMA, Radius, Sanofi, Seattle Genetics, Dignitana, Zymeworks, Phoenix Molecular Designs, Ltd., Celcuity, Cytomx, Dantari, G1 Therapeutics, Greenwich Life Sciences, Loxo Oncology, orinove, Orum; Financial Interests, Institutional, Research Grant: Ambrx; Financial Interests, Invited Speaker: Greenwich Life Sciences, Orum; Non-Financial Interests, Advisory Role: Daiichi Sankyo, Novartis, Ambrx, 4DPharma, Dantari, Macrogenics, Lilly, Artios, Roche, Pyxis, Amgen, Pieris, Arvinas, Immunomedics/Gilead, Briacell, Jazz Pharmaceuticals, Boehringer Ingelheim, Stemline/Menarini; Non-Financial Interests, Principal Investigator: Daiichi Sankyo, Genentech, Seattle Genetics; Non-Financial Interests, Member: ASCO, AACR; Non-Financial Interests, Other, speaker: National Breast Cancer Coalition; Non-Financial Interests, Member, site representative for breast cancer guidelines: National Comprehensive Cancer Network. All other authors have declared no conflicts of interest.