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Lord SJ, Kiely BE, O'Connell DL, Daniels B, Beith J, Smith AL, Pearson SA, Chiew KL, Bulsara MK, Houssami N. Characteristics and post-metastasis survival of recurrent metastatic breast cancer over time - An Australian population-based record linkage study, 2001-2016. Eur J Cancer 2024; 197:113468. [PMID: 38061215 DOI: 10.1016/j.ejca.2023.113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Abstract
AIM To assess population-level characteristics and post-metastasis survival of people with recurrent metastatic breast cancer (rMBC) during a period when new publicly-subsidised adjuvant and metastatic systemic therapies became available. METHODS Record linkage study of females in NSW Cancer Registry (NSWCR) diagnosed with non-metastatic breast cancer (BC) in 2001-2002 (C1) and 2006-2007 (C2). We identified first rMBC from NSWCR, administrative hospital records, dispensed medicines and radiotherapy services (2001-2016). We used death registrations to estimate cumulative incidence of BC death. RESULTS The analysis included 2267 women with rMBC (C1:1210, C2:1057). Compared to C1, C2 had access to adjuvant HER2-targeted therapy and were more likely to have received adjuvant chemotherapy (C1:38%, C2:47%) and aromatase inhibitors (C1:52%, C2:73%, of those dispensed endocrine therapy). Five-year probability of BC death was 65% (95%CI:62-68%) in C1 and 63% (95%CI:60-66%) in C2. Regional disease (T4 or N + ) at initial BC diagnosis (C1:62%, C2:68%), and age ≥ 70 years at first metastasis (C1:27%, C2:31%) were more common in C2 and had poorer prognosis. Five-year probability of BC death was lower in C2 than C1 for treatment-defined HER2-positive BC (C1:72% 95%CI:63-79%; C2:52% 95%CI 45-60%) and those dispensed chemotherapy alone (C1:76% 95%CI:69-82, C2:67% 95%CI:59-74%, p = 0.01), but not treatment-defined hormone receptor-positive HER2-negative BC (C1:60% 95%CI 56-63%, C2:64% 95%CI 60-68%). CONCLUSIONS Despite less favourable prognostic characteristics in C2, BC-related survival following rMBC was similar between the two cohorts; and improved for women with HER2-positive tumours. These findings support the real-world benefits of newer treatments for rMBC.
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Affiliation(s)
- Sarah J Lord
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia; The School of Medicine, University of Notre Dame Australia, Darlinghurst, Australia; NHMRC Centre of Research Excellence in Medicines Intelligence, Australia.
| | - Belinda E Kiely
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Australia
| | - Benjamin Daniels
- NHMRC Centre of Research Excellence in Medicines Intelligence, Australia; Medicines Intelligence Research Program, School of Population Health, UNSW Sydney, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, Australia
| | - Andrea L Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Sallie-Anne Pearson
- NHMRC Centre of Research Excellence in Medicines Intelligence, Australia; Medicines Intelligence Research Program, School of Population Health, UNSW Sydney, Australia
| | - Kim-Lin Chiew
- Cancer Services Division, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Max K Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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