Measures of Outcome in Metastatic Breast Cancer: Insights From a Real‐World Scenario. (2nd May 2014)

• Record Type: Journal Article
• Authors: Bonotto, Marta; Gerratana, Lorenzo; Poletto, Elena; Driol, Pamela; Giangreco, Manuela; Russo, Stefania; Minisini, Alessandro M.; Andreetta, Claudia; Mansutti, Mauro; Pisa, Federica E.; Fasola, Gianpiero; Puglisi, Fabio
• Is Part Of: Oncologist. Volume 19:Number 6(2014)
• Page Start: 608
• Page End: 615
• Publication Date: 2014-05-02
• Subjects: Outcome measure -- Surrogate endpoint -- Survival analysis -- Breast neoplasms; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2014-0002
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract : No gold standard treatment exists for metastatic breast cancer (MBC). Clinical decision making is based on knowledge of prognostic and predictive factors that are extrapolated from clinical trials and, sometimes, are not reliably transferable to a real‐world scenario. Moreover, misalignment between endpoints used in drug development and measures of outcome in clinical practice has been noted. The roles of overall survival (OS) and progression‐free survival (PFS) as primary endpoints in the context of clinical trials are the subjects of lively debate. Information about these parameters in routine clinical practice is potentially useful to design new studies and/or to interpret the results of clinical research. This study analyzed the impact of patient and tumor characteristics on the major measures of outcome across different lines of treatment in a cohort of 472 patients treated for MBC. OS, PFS, and postprogression survival (PPS) were analyzed. The study showed how biological and clinical characteristics may have different prognostic value across different lines of therapy for MBC. After first‐line treatment, the median PPS of luminal A, luminal B, and human epidermal growth factor receptor 2 (HER2)‐positive groups was longer than 12 months. The choice of OS as a primary endpoint for clinical trials could not be appropriate with these subtypes. In contrast, OS could be an appropriate endpoint when PPS is expected to be low (e.g., triple‐negative subtype after the first line; other subtypes after the third line). The potential implications of these findings are clinical and methodological. Abstract : The present study provides data about outcomes of consecutive metastatic breast cancer patients treated at an academic hospital. The findings support the importance of considering breast cancer in distinct subgroups with the aim of obtaining more precise information about prognosis and expected benefit from treatment. The study also provides insights for future clinical trial design.