Clinical decision making in patients with metastatic breast sancer in the United Kingdom (UK) and Italy

Abstract

Background: Several treatment options are available for metastatic breast cancer (MBC), but guidelines may not specify, for example, the nature, number and sequence to be used. The aim of this study was to compare treatment strategies between two oncology Centers in the UK and Italy. Methods: We retrospectively collected disease characteristics, demographic and treatment data of 228 consecutive patients ( pts) diagnosed with MBC at the University Hospitals of Leeds (UK) and Udine (Italy) between January 2012 and December 2013 who received at least one line of therapy. The cohorts were compared using Chi square test or Fisher exact test as appropriate. Overall Survival (OS) was analyzed by log-rank test. Results: We identified 120 UK and 108 Italian pts; median follow-up from the diagnosis of MBC was 41 and 38 months, respectively. The UK and Italian patients were similar with respect to clinical and pathological characteristics. Median age was 64 years; hormone receptor (HR) +ve rates were 88% vs. 80 % for the UK and Italian pts, respectively while 26% and 24% of pts respectively were classified as HER2 +ve. When diagnosed with MBC, visceral metastases were present in 54% vs. 47% of the UK and Italian pts, respectively. Fifty-one percent of UK pts and 43% of Italian pts underwent biopsy before first line treatment for MBC. The number of systemic treatment lines was the same for the two Centers (median 2; range 1-7). Analyzing first line treatment, a similar proportion of UK and Italian pts with HR +ve /HER2 -ve disease received endocrine therapy (55% vs. 49%) and chemotherapy (45% vs. 51%); the presence of visceral metastases increased the likelihood of chemotherapy being preferred as first line therapy in the UK but not Italy (64% vs 52%, respectively). As of December 2015, 63% and 56% of pts from Leeds and Udine, respectively had died. The median OS was 28 vs 27 months for the UK and Italian pts, respectively. No significant differences were observed in the time between the start of the final line of systemic therapy and death (7 vs. 8 month in UK and Italian pts, respectively). Conclusions: So far, we have not identified significant differences in the management of MBC pts between the two Centers or in OS outcomes between English and Italian pts. More detailed analyses are ongoing.