Real-world time trends in overall survival, treatments and patient characteristics in HR+/HER2- metastatic breast cancer: an observational study of the SONABRE Registry

Marissa Meegdes; Sandra M E Geurts; Frans L G Erdkamp; M Wouter Dercksen; Birgit E P J Vriens; Kirsten N A Aaldering; Manon J A E Pepels; Linda M H van de Winkel; Natascha A J B Peters; Jolien Tol; Joan B Heijns; Agnes J van de Wouw; Aude J O de Fallois; Maartje A C E van Kats; Vivianne C G Tjan-Heijnen

doi:10.1016/j.lanepe.2022.100573

Real-world time trends in overall survival, treatments and patient characteristics in HR+/HER2- metastatic breast cancer: an observational study of the SONABRE Registry

Lancet Reg Health Eur. 2023 Jan 6:26:100573. doi: 10.1016/j.lanepe.2022.100573. eCollection 2023 Mar.

Authors

Marissa Meegdes¹, Sandra M E Geurts¹, Frans L G Erdkamp², M Wouter Dercksen³, Birgit E P J Vriens⁴, Kirsten N A Aaldering⁵, Manon J A E Pepels⁶, Linda M H van de Winkel⁷, Natascha A J B Peters⁸, Jolien Tol⁹, Joan B Heijns¹⁰, Agnes J van de Wouw¹¹, Aude J O de Fallois¹, Maartje A C E van Kats¹, Vivianne C G Tjan-Heijnen¹

Affiliations

¹ Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands.
² Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.
³ Department of Medical Oncology, Máxima Medical Center, Eindhoven, the Netherlands.
⁴ Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands.
⁵ Department of Internal Medicine, Laurentius Hospital, Roermond, the Netherlands.
⁶ Department of Internal Medicine, Elkerliek Hospital, Helmond, the Netherlands.
⁷ Department of Internal Medicine, St Anna Hospital, Geldrop, the Netherlands.
⁸ Department of Internal Medicine, St. Jans Gasthuis, Weert, the Netherlands.
⁹ Department of Internal Medicine, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands.
¹⁰ Department of Internal Medicine, Amphia Hospital Breda, the Netherlands.
¹¹ Department of Internal Medicine, Viecuri Medical Centre, Venlo, the Netherlands.

Abstract

Background: This study aims to evaluate whether changes in therapeutic strategies have improved survival of patients diagnosed with hormone receptor positive (HR+), HER2 negative (HER2-) advanced breast cancer (ABC) in real-world.

Methods: All 1950 patients systemically treated for HR+/HER2- ABC and diagnosed between 2008 and 2019 in eight hospitals were retrieved from the SONABRE Registry (NCT-03577197). Patients were categorized per three-year cohorts based on year of ABC diagnosis. Tests for trend were used to examine differences in baseline characteristics, Kaplan-Meier methods and Cox proportional hazards for survival analyses, and competing-risk methods for 3-year use of systemic therapy.

Findings: Over time, patients were older (≥70 years, 37%, n = 169/456 in 2008-2010, 47%, n = 233/493 in 2017-2019, p = 0.004) and more often had multiple metastatic sites at ABC diagnosis (48%, n = 220/456 in 2008-2010, 56%, n = 275/493 in 2017-2019, p = 0.002). Among patients with metachronous metastases the prior exposure to (neo-) adjuvant therapies increased over time (chemotherapy, 38%, n = 138/362 in 2008-2010, 48%, n = 181/376 in 2017-2019, p = <0.001; endocrine therapy, 64%, n = 231/362 in 2008-2010, 72%, n = 271/376 in 2017-2019, p = <0.001). Overall survival significantly improved from median 31.1 months (95% CI:28.2-34.3) for patients diagnosed in 2008-2010 to 38.4 months (95% CI:34.0-41.1) in 2017-2019 (adjusted hazard ratio = 0.76, 95% CI:0.64-0.90; p = 0.001). Three-year use of CDK4/6 inhibitors increased from 0% for patients diagnosed in 2008-2010 to 54% for diagnosis in 2017-2019. Conversely, three-year use of chemotherapy was 50% versus 36%, respectively.

Interpretation: Over time, patients diagnosed with HR+/HER2- ABC presented with less favourable patient characteristics. Nevertheless, we observed that overall survival of ABC increased between 2008 and 2019, with increased use of endocrine/targeted therapies.

Funding: The SONABRE Registry is supported by the Netherlands Organization for Health Research and Development (ZonMw: 80-82500-98-8003); Novartis BV; Roche; Pfizer; and Eli Lilly & Co. Funding sources had no role in the writing of the manuscript.

Keywords: CDK4/6 inhibitors; Metastatic breast cancer; Real-world; Registry; Survival.