372P - Is capecitabine (CAPE) the best treatment (trt) option for estrogen receptor-positive (ER+) HER2-negative (HER2-) metastatic breast cancer (MBC) after progression on endocrine treatment (ET): An analysis of the ESME real-world database

Background

The current standard trt for ER+ HER2- MBC is a combination of ET and a CDK4/6 inhibitor (iCDK4/6). Once all ET options have been exhausted, chemotherapy (CT) is the cornerstone trt. CAPE is frequently prescribed as first-line (L1) CT trt in this setting, although no controlled study has validated such choice. We used the real world ESME database to compare the effectiveness of CAPE and intra-venous (IV) CT as L1 trt after tumor progression on ET.

Methods

The French ESME MBC database is a national cohort of all consecutive patients (pts) who initiated a L1 trt for MBC since 2008 in one of the 18 French Comprehensive Cancer Centers. Overall survival (OS) from time of CT initiation was compared between the two groups using Cox models including all prognostic factors and a propensity score, without and with adjustment. Prognostic factors included age, performance status, metastatic sites, number of metastatic sites, time to metastatic relapse, second-line (L2) or >L2 trt.

Results

In this database from 2008 to 2021, 4,158 pts with ER+ HER2- MBC out of 19,390 pts were treated with CAPE (1,573 pts) or IV CT (2,585 pts) as L1 CT after one or more lines of ET-based trt. Median follow-up was 87.2 months. Median age was 63 years (IQR 53-72). 71.3 % and 28.7 % of pts had respectively received L1 or >L1 previous ET. 26 % had received previous iCDK4/6. CAPE-treated pts were on average 5 years older, had more often bone metastases only and fewer metastatic sites. In the multivariable analysis, after adjusting on the major prognostic factors and matching on a propensity score, median OS was significantly higher with CAPE (23.6 months with CAPE versus 19.7 months with IV CT, p = 0.0360). These results were identical for the iCDK4/6-treated subgroup.

Conclusions

In this large multicenter real-world cohort, a statistical analysis using a propensity score shows a significant higher OS with CAPE, compared to IV CT, when prescribed after ET among pts with ER+ HER2- MBC. Despite the limitations of this retrospective analysis, these data provide solid arguments to allow CAPE prescribing after progression on ET.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Unicancer.

Funding

Has not received any funding.

Disclosure

C. Pflumio: Financial Interests, Personal, Advisory Board: Novartis; Non-Financial Interests, Personal, Non financial benefits, Congress: Lilly, Pfizer, Merck, Novartis; Financial Interests, Personal, Invited Speaker: Seagen, Lilly. P.H. Cottu: Financial Interests, Personal, Advisory Board: pfizer, roche; Financial Interests, Personal, Invited Speaker: pfizer, lilly; Financial Interests, Institutional, Invited Speaker: daichi, lilly, gilead; Financial Interests, Institutional, Funding: Novartis. M. Leheurteur: Financial Interests, Institutional, Invited Speaker: Seagen, Astrazeneca; Financial Interests, Institutional, Local PI: Gilead, Msd, Novartis, Gsk; Non-Financial Interests, Personal, Other, Invitation congres: Lilly, Msd, Daichi. F. Dalenc: Financial Interests, Institutional, Advisory Board: Novartis, MSD, DAICHI SANKO, ASTRAZENECA; Financial Interests, Institutional, Steering Committee Member: ASTRAZENECA; Non-Financial Interests, Principal Investigator: ROCHE, gilead, Novartis; Non-Financial Interests, Advisory Role: AstraZeneca. W. Jacot: Financial Interests, Personal, Advisory Board: AstraZeneca, Eisai, Novartis, Roche, Pfizer, Eli Lilly, MSD, BMS, Chugai, Seagen, Daiichi Sankyo; Financial Interests, Personal, Invited Speaker: AstraZeneca, Pfizer, Seagen, Daiichi Sankyo; Financial Interests, Personal, Advisory Board, Advisory Board: Gilead; Financial Interests, Institutional, Research Grant: AstraZeneca, Daiichi Sankyo; Financial Interests, Coordinating PI: Roche, Daiichi Sankyo; Financial Interests, Local PI: Roche, Novartis, Daiichi Sankyo. A. Mailliez: Financial Interests, Institutional, Invited Speaker: Astrazeneca, MSD, Novartis, Roche; Financial Interests, Personal, Invited Speaker: Menarini, Oseus, Seagen, Pfizer, Daiichi Sankyo; Financial Interests, Personal, Advisory Board: GSK. C. Levy: Financial Interests, Personal, Advisory Board: Daiichi, AstraZeneca, Lilly; Non-Financial Interests, Personal, Non financial benefits, Congress: Pfizer, Lilly, Daiichi; Financial Interests, Personal, Invited Speaker: Novartis, Lilly, Seagen. O. Tredan: Financial Interests, Personal, Advisory Board: Roche, Pfizer, Novartis-Sandoz, Lilly, MSD, AstraZeneca, Pierre Fabre Oncologie, Seagen, Daiichi Sankyo, Gilead, Eisai, Stemline-Menarini, Veracyte, Exact Sciences. A. Gonçalves: Financial Interests, Institutional, Advisory Board: AstraZeneca, Novartis, msd, innate pharma, parexel, gilead; Financial Interests, Institutional, Local PI: Novartis, AstraZeneca, daiichy sanko; Financial Interests, Institutional, Coordinating PI: Roche, MSD; Other, travel accomadation meeting regsitration: mylan; Other, travel accomodation meeting registration: Novartis; Other, travel, accomodation, meeting registration: roche, menarini. M. Robert: Financial Interests, Institutional, Advisory Board: AstraZeneca; Non-Financial Interests, Personal, Other, travel and congress fees: AstraZeneca; Non-Financial Interests, Personal, Training: Novartis. C. Bailleux: Financial Interests, Personal, Advisory Board: Novartis, AstraZeneca; Financial Interests, Personal, Invited Speaker: Novartis, Lilly, Seagen, AstraZeneca; Financial Interests, Personal, Stocks/Shares, <1%: SigBio. S. Delaloge: Financial Interests, Institutional, Advisory Board: Novartis, Sanofi, Gilead; Financial Interests, Institutional, Invited Speaker: Pfizer; Financial Interests, Institutional, Advisory Board, ad board: Besins Healthcare; Financial Interests, Institutional, Invited Speaker, ESMO symposium: Gilead; Financial Interests, Institutional, Advisory Board, scientific board: Elsan; Financial Interests, Institutional, Steering Committee Member: Roche Genentech, BMS, Sanofi; Non-Financial Interests, Member of Board of Directors, Société Française de Sénologie et Pathologie Mammaire: SFSPM; Non-Financial Interests, Principal Investigator, H2020 funding: European Commission. L. Bosquet: Financial Interests, Institutional, Full or part-time Employment, In charge of scientific projects at Unicancer, Health Data and Partnership Department: Unicancer. T. Petit: Financial Interests, Personal, Advisory Board: Pfizer, Lilly, MSD, AstraZeneca, Seagen, Daïchi, Menarini, Exact Sciences. All other authors have declared no conflicts of interest.