Abstract 306P
Background
Young women with breast cancer (BC) deserve a specific approach given peculiar issues including fertility, genetics and psychosocial concerns. De novo metastatic BC (MBC) in young women is a dramatic situation for which limited data are available.
Methods
We evaluated the management and outcomes of women ≤ 40 yo diagnosed with de novo MBC in a national multicenter real-life cohort of 22463 consecutive patients treated between 2008 and 2016 (NCT0327531). Our primary objective was to describe this population; second objectives was to compare the progression free survival (PFS) and overall survival (OS) with those of older women.
Results
Out of the 5997 women with de novo MBC in the database, 598 (10%) were ≤ 40 yo. Median age at MBC was 36 yo [20-40]. Hormone receptor (HR) and HER2 status were distributed as follows: HR+/HER2- (n=289; 48.3 %); HER2+ (n=207; 34.6 %) and HR-/HER2- (TNBC) (n=102; 17.1 %). Compared with women > 40 yo, young women had more frequently grade III tumors (49% vs. 33.8%), HER2+ disease (34.6% vs. 24.3%) and TNBC (17.1% vs. 12.1%), liver metastases were more frequent at initial presentation (38.1% vs. 28.7%) and surgery of the primary was more often performed (41.7% vs. 29.2%) (p<0.0001). In women ≤40yo, BRCA testing at any time of the disease was known for 43% (n=260) of patients, with a BRCA1/2 mutation identified in 44 patients (17% of tested). In HR+/HER2- patients, chemotherapy was selected as frontline treatment in the vast majority of young patients compared to older ones (89.6% versus 55.9% respectively, p<0.0001). After a median follow up of 48.2 months (mo), median OS of young women was 58.5 mo, 20.7 mo, and not reached in HR+/HER2-, TNBC and HER2+ subgroups respectively. Young women had a significantly better OS (unadjusted) compared with older ones, except for the TNBC subgroup in which results were similar.
Conclusions
In this real-life setting, 10% patients with de novo MBC are ≤ 40 yo. Age driving first-line strategy with various effects on outcome according to phenotype, specific questions regarding treatment choice are still relevant and should be addressed prospectively.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
R&D Unicancer.
Funding
Has not received any funding.
Disclosure
B. Pistilli: Advisory/Consultancy: Puma Biotechnology; Speaker Bureau/Expert testimony: Pierre Fabre, Novartis, Myriad Genetics; Travel/Accommodation/Expenses: MSD Oncology, AstraZeneca, Novastis, Pfizer. E. Brain: Honoraria (self): AstraZeneca, BMS, Celgene, Clinigen, G1 Therapeutics, Hospira, Janssen, Mylan, OBI Pharma, Pfizer, Puma, Roche, Samsung; Honoraria (institution): Amgen, BMS, HalioDX (Qiagen/Ipsogen), TEVA (Cephalon) ; Travel/Accommodation/Expenses: AstraZeneca, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz. A. Gonçalves: Honoraria (institution): Novartis, MSD, Lilly; Research grant/Funding (institution): Novartis, MSD; Travel/Accommodation/Expenses: Roche, AstraZeneca, Pfizer, Novartis. T. de La Motte Rouge: Advisory/Consultancy: AstraZeneca, Clovis Oncology, Tesaro GSK, Pfizer, Roche; Research grant/Funding (institution): Pfizer, Novartis, MSD; Travel/Accommodation/Expenses: AstraZeneca, Clovis Oncology, Tesaro GSK, Pfizer, Roche. J-S. Frenel: Advisory/Consultancy: Roche, AstraZeneca, Lilly, Pfizer, GSK, Esai, Novartis; Travel/Accommodation/Expenses: Roche, AstraZeneca, Lilly, Pfizer, Novartis. All other authors have declared no conflicts of interest.