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Treatment and outcomes in patients with central nervous system metastases from breast cancer in the real-life ESME MBC cohort.
European Journal of Cancer ( IF 8.4 ) Pub Date : 2019-12-10 , DOI: 10.1016/j.ejca.2019.11.001
David Pasquier 1 , Amélie Darlix 2 , Guillaume Louvel 3 , Julien Fraisse 4 , William Jacot 5 , Etienne Brain 6 , Adeline Petit 7 , Marie Ange Mouret-Reynier 8 , Anthony Goncalves 9 , Florence Dalenc 10 , Elise Deluche 11 , Jean Sébastien Fresnel 12 , Paule Augereau 13 , Jean Marc Ferrero 14 , Julien Geffrelot 15 , Jean-David Fumet 16 , Isabelle Lecouillard 17 , Paul Cottu 6 , Thierry Petit 18 , Lionel Uwer 19 , Christelle Jouannaud 20 , Marianne Leheurteur 21 , Véronique Dieras 17 , Mathieu Robain 22 , Raphaelle Mouttet-Audouard 23 , Thomas Bachelot 24 , Coralie Courtinard 22
Affiliation  

AIM The aims of the present study were to describe treatment patterns and survival outcomes in patients with central nervous system metastases (CNSM) selected among metastatic breast cancer (MBC) patients included in a retrospective study from the Epidemiological Strategy and Medical Economics (ESME) MBC cohort. METHODS Neurological progression-free survival (NPFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Significant contributors to NPFS were determined using a multivariate Cox proportional hazards model. RESULTS After a median follow-up of 42.8 months, of 16 701 patients included in the ESME MBC database, CNSM were diagnosed in 24.6% of patients. The most frequent treatments after diagnosis of CNSM were whole-brain radiotherapy (WBRT) (45.2%) and systemic treatment (59.3%). Median OS and NPFS were 7.9 months (95% CI: 7.2-8.4) and 5.5 months (95% CI: 5.2-5.8), respectively. In multivariate analysis, age >70 years (vs <50 years; HR = 1.40; 95% CI: 1.24-1.57), triple-negative tumours (vs HER2-/HR+; HR = 1.87; 95% CI: 1.71-2.06), HER2+/HR-tumours (vs HER2-/HR+; HR = 1.14; 95% CI: 1.02-1.27), ≥3 metastatic sites (vs < 3; HR = 1.32; 95% CI: 1.21-1.43) and ≥3 previous treatment lines (vs < 3; HR = 1.75; 95% CI: 1.56-1.96) were detrimental for NPFS. A time interval between selection and CNSM diagnosis superior to 18 months (vs <9 months; HR = 0.88; 95% CI: 0.78-0.98) was associated with longer NPFS. CONCLUSIONS This study describes current treatment patterns of MBC patients in a "real life" setting. Despite advances in stereotactic radiation therapy, most of the patients still received WBRT. More research is warranted to identify patient subsets for tailored treatment strategies.

中文翻译:

在现实生活中的ESME MBC队列中,患有乳腺癌的中枢神经系统转移患者的治疗和结局。

目的本研究的目的是描述从流行病学策略和医学经济学(ESME)MBC进行的回顾性研究中选择的转移性乳腺癌(MBC)患者中选择的中枢神经系统转移(CNSM)患者的治疗方式和生存结果队列。方法采用Kaplan-Meier方法评估神经无进展生存期(NPFS)和总生存期(OS)。使用多变量Cox比例风险模型确定了NPFS的重要贡献者。结果在平均随访42.8个月后,ESME MBC数据库中包括16 701例患者,其中24.6%的患者被诊断为CNSM。诊断为CNSM后最常见的治疗方法是全脑放射治疗(WBRT)(45.2%)和全身治疗(59.3%)。OS和NPFS的中位数为7。分别为9个月(95%CI:7.2-8.4)和5.5个月(95%CI:5.2-5.8)。在多变量分析中,年龄> 70岁(vs <50岁; HR = 1.40; 95%CI:1.24-1.57),三阴性肿瘤(vs HER2- / HR +; HR = 1.87; 95%CI:1.71-2.06) ,HER2 + / HR肿瘤(vs HER2- / HR +; HR = 1.14; 95%CI:1.02-1.27),≥3个转移部位(vs <3; HR = 1.32; 95%CI:1.21-1.43)和≥3先前的治疗系(vs <3; HR = 1.75; 95%CI:1.56-1.96)对NPFS有害。选择和CNSM诊断之间的时间间隔超过18个月(vs <9个月; HR = 0.88; 95%CI:0.78-0.98)与更长的NPFS相关。结论这项研究描述了MBC患者在“现实生活”中的当前治疗方式。尽管立体定向放射疗法取得了进步,但大多数患者仍接受WBRT。
更新日期:2019-12-10
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