Abstract 344P
Background
Although the prognosis of metastatic breast cancer (MBC) has improved, several patients (pts) still develop sooner or later high burden metastases (mets) with function alterations or visceral crisis (VC). For these pts, polichemotherapy is commonly used and recommended by clinical guidelines in VC. Data reporting the real effectiveness of this strategy are scanty. Outcomes of MBC pts treated with platinum-based polichemotherapy (P-CT) at the Institut Jules Bordet (IJB) during a period of 10 years were reviewed.
Methods
Retrospective review of medical charts of pts with MBC receiving P-CT in IJB between Jan 2008 and Dec 2018. VC was defined according to ABC 4 criteria. Overall survival (OS) was estimated by Kaplan-Meier and comparisons by log-rank test. Cox proportional hazards models was used for multivariate analysis.
Results
441 pts were identified: 370 (84%) with disease recurrence and 71 (16%) with de-novo MBC. As for MBC subtype, 180 (41%) had ER-positive (ER+)/HER2-negative (HER2-), 116 (26%) ER+/HER2+, 34 (8%) ER-/HER2+, and 111 (25%) triple negative BC. Visceral mets were observed in 430 (97.5%) pts and 261 (59%) presented VC. VC involved mainly liver dysfunction (n=134), lung lymphangitis (n=45), symptomatic brain mets (n=28), peritoneal carcinomatosis with bowel obstruction (n=25) and leptomeningeal mets (n=22). Median OS with P-CT in the entire cohort was 6.1 months, without differences by MBC subtype (p=0.076). Pts with VC had statistically lower OS than pts without VC (3.7 vs. 8.6 months; p<0.001). On multivariate analysis, the variables statistically correlated with worse OS were: hyperbilirubinemia (HR 1.92; 95% CI 1.33-2.77; p<0.001), ECOG ≥2 (HR 1.66; 95% CI 1.03-2.65; p=0.035) and ECOG ≥3 (HR 2.43; 95% CI 1.35-4.05, p=0.002), >3 previous treatment lines (HR 2.25; 95% CI 1.53-3.32, p<0.001). Of the 261 pts with VC, 106 (40.5%) presented a resolution of VC which was correlated with better OS (9.3 vs. 2.0 months, HR 0.25; 95% CI 0.19-0.34; p<0.001).
Conclusions
Pts who overcome VC benefit from P-CT with OS similar to pts without VC. Hyperbilirubinemia, poor ECOG and >3 previous treatment lines are significant prognosis factors and could be markers of futility for this treatment in MBC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Institut Jules Bordet.
Funding
Has not received any funding.
Disclosure
D. Eiger: Research grant/Funding (self), Funding for his fellowship (2018-2019): Novartis. A.H. Awada: Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Amgen; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Eisai; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): BMS; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Pfizer; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Novartis; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): MSD; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Genomic Health; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Ipsen; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): AstraZeneca; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Bayer; Advisory/Consultancy, Speaker Bureau/Expert testimony: Leo Pharma. E. de Azambuja: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche/ GNE; Honoraria (self), Advisory/Consultancy: Novartis; Honoraria (self), Advisory/Consultancy: Seattle Genetics; Travel/Accommodation/Expenses: GSK/Novartis; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Servier. All other authors have declared no conflicts of interest.