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Breast cancer patients treated with intrathecal therapy for leptomeningeal metastases in a large real-life database
- Source :
- ESMO Open, ESMO Open, European Society for Medical Oncology, 2021, 6 (3), pp.100150. ⟨10.1016/j.esmoop.2021.100150⟩, ESMO Open, 2021, 6 (3), pp.100150. ⟨10.1016/j.esmoop.2021.100150⟩
- Publication Year :
- 2021
-
Abstract
- Background Leptomeningeal metastasis (LM) is a rare complication of metastatic breast cancer (MBC), with high morbidity/mortality rates. Our study aimed to describe the largest-to-date real-life population of MBC patients treated with intrathecal (IT) therapy and to evaluate prognostic models. Methods The Epidemiological Strategy and Medical Economics (ESME) MBC database (NCT03275311) includes all consecutive patients who have initiated treatment for MBC since 2008. Overall survival (OS) of patients treated with IT therapy was estimated using the Kaplan–Meier method. Prognostic models were constructed using Cox proportional hazards models. Performance was evaluated using C-index and calibration plots. Results Of the 22 266 patients included in the database between 2008 and 2016, 312 received IT therapy and were selected for our analysis. Compared with non-IT-treated patients, IT-treated patients were younger at MBC relapse (median age: 52 years versus 61 years) and more often had lobular histology (23.4% versus 12.7%) or triple-negative subtype (24.7% versus 13.3%) (all P < 0.001). Median OS was 4.5 months [95% confidence interval (CI) 3.8-5.6] and 1-year survival rate was 25.6%. Significant prognostic factors associated with poorer outcome on multivariable analysis were triple-negative subtype (hazard ratio 1.81, 95% CI 1.32-2.47), treatment line ≥3 (hazard ratio 1.88, 95% CI 1.30-2.73), ≥3 other metastatic sites (hazard ratio 1.33, 95% CI 1.01-1.74) and IT cytarabine or thiotepa versus methotrexate (hazard ratio 1.68, 95% CI 1.28-2.22), while concomitant systemic therapy was associated with better OS (hazard ratio 0.47, 95% CI 0.35-0.62) (all P < 0.001). We validated two previously published prognostic scores, the Curie score and the Breast-graded prognostic assessment, both with C-index of 0.57. Conclusions MBC patients with LM treated with IT therapy have a poor prognosis. We could identify a subgroup of patients with better prognosis, when concomitant systemic therapy and IT methotrexate were used.<br />Highlights • The outcome of BC patients with IT-treated LM is poor, with a median OS of 4.5 months. • Concomitant systemic therapy may improve the outcome in IT-treated patients. • Patients treated with IT methotrexate had better outcome than those treated with IT cytarabine/thiotepa. • The Curie and Breast-graded prognostic assessment scores were prognostic for IT-treated patients.
- Subjects :
- Cancer Research
Population
Breast Neoplasms
computer.software_genre
03 medical and health sciences
intrathecal therapy
0302 clinical medicine
Breast cancer
breast cancer
leptomeningeal metastasis
cohort study
Medicine
Humans
Breast
education
Survival rate
Original Research
education.field_of_study
Database
business.industry
Proportional hazards model
Mortality rate
Hazard ratio
Middle Aged
medicine.disease
Prognosis
Metastatic breast cancer
3. Good health
Oncology
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
030220 oncology & carcinogenesis
Concomitant
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Female
Neoplasm Recurrence, Local
business
computer
Meningeal Carcinomatosis
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 20597029
- Volume :
- 6
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- ESMO open
- Accession number :
- edsair.doi.dedup.....664404b88be174225901ee6670286eb6
- Full Text :
- https://doi.org/10.1016/j.esmoop.2021.100150⟩