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Breast Cancer Research and Treatment

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01-05-2020 | Breast Cancer | Epidemiology

Comparison of outcomes in a population-based cohort of metastatic breast cancer patients receiving anti-HER2 therapy with clinical trial outcomes

Authors: Inna Y. Gong, Andrew T. Yan, Craig C. Earle, Maureen E. Trudeau, Andrea Eisen, Kelvin K. W. Chan

Published in: Breast Cancer Research and Treatment | Issue 1/2020

Abstract

Purpose

Little data exist for comparing cardiac safety and survival outcomes of trastuzumab/pertuzumab or ado-T emtansine (TDM1) in metastatic breast cancer (MBC) patients enrolled in randomized clinical trial (RCT) vs the real-world.

Methods

This was a retrospective population-based cohort of all patients with MBC treated with trastuzumab/pertuzumab or TDM1 (2012–2017) in Ontario, Canada. Outcomes were incident heart failure (HF) and overall survival (OS). RCT data were obtained from digitizing survival curves and compared with cohort data using Kaplan–Meier analysis. Age-based comparison of outcomes was conducted for patients ≥ 65 years old vs younger than 65.

Results

The two cohorts composed of 833 and 397 patients treated with trastuzumab/pertuzumab and TDM1, of whom 5.5% and 7.6% had baseline HF, respectively. Incident HF following trastuzumab/pertuzumab or TDM1 was low (trastuzumab/pertuzumab 1.8 events/100 person years; TDM1 0.02 events/100 person years). The median OS was 39.2 and 56.4 months in the trastuzumab/pertuzumab population-based cohort and CLEOPATRA, respectively. The median OS was 15.4 and 30.9 months in the TDM1 population-based cohort and EMILIA, respectively. Cohort OS was significantly worse than RCT OS (trastuzumab/pertuzumab HR 1.67, 95% CI 1.37–2.03, p < 0.0001; TDM1 HR 2.80, 95% CI 2.27–3.44, p < 0.0001). Older patients had worse OS than younger patients for trastuzumab/pertuzumab (HR 1.60, 95% CI 1.19–2.16, p = 0.0018), but not for TDM1 (HR 1.16, 95% CI 0.81–1.66, p = 0.43).

Conclusion

HF incidence during trastuzumab/pertuzumab or TDM1 therapy in this real-world cohort was low. Survival in this cohort was worse compared to RCT, suggesting that recruitment of patients similar to the real-world population is required.

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Title: Comparison of outcomes in a population-based cohort of metastatic breast cancer patients receiving anti-HER2 therapy with clinical trial outcomes
Authors: Inna Y. Gong
Andrew T. Yan
Craig C. Earle
Maureen E. Trudeau
Andrea Eisen
Kelvin K. W. Chan
Publication date: 01-05-2020
Publisher: Springer US
Keywords: Breast Cancer
Heart Failure
Breast Cancer
Anthracycline
Pertuzumab
Trastuzumab
Published in: Breast Cancer Research and Treatment / Issue 1/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05614-5

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