Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context
Summary: Background: Abemaciclib is currently approved for the adjuvant treatment of high-risk, lymph node (LN)-positive, hormone receptor (HR)-positive breast cancer (BC). In a real-world setting the clinicopathologic features of patients potentially eligible for adjuvant abemaciclib remain to be...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024001317 |
| _version_ | 1797253904651517952 |
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| author | Francesca Magnoni Giovanni Corso Patrick Maisonneuve Beatrice Bianchi Giuseppe Accardo Claudia Sangalli Giulia Massari Anna Rotili Luca Nicosia Filippo Pesapane Emilia Montagna Giovanni Mazzarol Viviana Galimberti Paolo Veronesi Giuseppe Curigliano |
| author_facet | Francesca Magnoni Giovanni Corso Patrick Maisonneuve Beatrice Bianchi Giuseppe Accardo Claudia Sangalli Giulia Massari Anna Rotili Luca Nicosia Filippo Pesapane Emilia Montagna Giovanni Mazzarol Viviana Galimberti Paolo Veronesi Giuseppe Curigliano |
| author_sort | Francesca Magnoni |
| collection | DOAJ |
| description | Summary: Background: Abemaciclib is currently approved for the adjuvant treatment of high-risk, lymph node (LN)-positive, hormone receptor (HR)-positive breast cancer (BC). In a real-world setting the clinicopathologic features of patients potentially eligible for adjuvant abemaciclib remain to be defined. There are conflicting data regarding the biological behavior and long-term outcomes across invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). In our study we retrospectively assessed the real-world data and long-term outcome of selected high-risk features ILC compared to IDC, according to the MonarchE trial inclusion criteria. Methods: We identified 15,071 patients who got surgery at the European Institute of Oncology for a first primary, non-metastatic, HR-positive, HER2-negative BC from 2000 to 2008. 11,981 (79.5%) patients had an IDC and 1524 (10.1%) an ILC. The remaining 1566 patients (10.4%) had either combined ductal and lobular breast cancer or another histological breast cancer subtype. According to the eligibility criteria of the MonarchE study, we identified two high-risk groups, based on high number of positive lymph nodes, large tumor size, or a high cellular proliferation as measured by tumor grade or biomarkers. Patients were matched by propensity score. Findings: A total of 2872 (21.3%) patients were selected as clinically high-risk, including 361/1524 ILC (23.7%) and 2511/11,981 IDC (21%). 322 high-risk ILC were matched with similar high-risk IDC. The median follow-up was 13.2 years for survival. In the matched set, invasive disease-free survival (IDFS) (log-rank P = 0.09) and overall survival (OS) (log-rank P = 0.48) were not statistically significantly different between the two histological groups. For IDC patients, the 5-year and 10-year IDFS rates (95% CI) were 77.7% (72.9–82.2) and 57.3% (51.7–63.1) respectively, compared to the 5-year and 10-year IDFS rates of ILC patients that were 75.5% (70.6–80.2) and 50.7% (45.0–56.6). The 5-year and 10-year distant relapse free survival (DRFS) rates were 80% (75.3–84.2) and 65.3% (59.8–70.7) in IDC cohort, compared to the 5-year and the 10-year DRFS rates of 78.7% (74.0–83.1) and 61.5% (55.9–67.1) in the ILC cohort. Such data match the recent outcomes efficacy results of the MonarchE control arm. More patients in the ILC (n = 17) than in the IDC group (n = 10) developed axillary recurrence. At multivariable analysis, stratified for specific clinical features, age <35 years, pT2-3, axillary involvement with more than 10 positive axillary nodes were found to be predictors of unfavorable IDFS and OS in the overall matched high-risk population. Interpretation: Findings from this matched cohort study reported similar IDFS and DRFS rates for high risk HR positive early BC when compared to the control arm overall IDFS and DRFS rates reported from the MonarchE trial. Our study demonstrated rates of concordant long-term outcome status beyond histologic subtype. These data support an escalation strategy for these two different histological entities when diagnosed with high-risk features. In our dataset approximately 21% rate of high-risk HR positive early BC patients are potentially eligible for adjuvant abemaciclib treatment. Funding: Umberto Veronesi Foundation. |
| first_indexed | 2024-04-24T21:41:28Z |
| format | Article |
| id | doaj.art-5a1c411c7ade4845974d93f55c272de9 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-24T21:41:28Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-5a1c411c7ade4845974d93f55c272de92024-03-21T05:37:20ZengElsevierEClinicalMedicine2589-53702024-05-0171102552Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in contextFrancesca Magnoni0Giovanni Corso1Patrick Maisonneuve2Beatrice Bianchi3Giuseppe Accardo4Claudia Sangalli5Giulia Massari6Anna Rotili7Luca Nicosia8Filippo Pesapane9Emilia Montagna10Giovanni Mazzarol11Viviana Galimberti12Paolo Veronesi13Giuseppe Curigliano14Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy; European Cancer Prevention Organization (ECP), 20141, Milan, Italy; Corresponding author. Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy.Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Italy; European Cancer Prevention Organization (ECP), 20141, Milan, ItalyDivision of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, ItalyDivision of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, ItalyDivision of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, ItalyData Management, European Institute of Oncology, IRCCS, Milan, ItalyDivision of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, ItalyBreast Imaging Division, IEO European Institute of Oncology, IRCCS, 20141, Milan, ItalyBreast Imaging Division, IEO European Institute of Oncology, IRCCS, 20141, Milan, ItalyBreast Imaging Division, IEO European Institute of Oncology, IRCCS, 20141, Milan, ItalyDivision of Medical Senology, European Institute of Oncology, IRCCS, 20141, Milan, ItalyDivision of Pathology, IEO European Institute of Oncology, IRCCS, Milan, ItalyDivision of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, ItalyDivision of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, ItalyDepartment of Oncology and Hemato-Oncology, University of Milano, Italy; Division of Experimental Therapeutics, Division of Medical Oncology, European Institute of Oncology, IRCCS, Milan, ItalySummary: Background: Abemaciclib is currently approved for the adjuvant treatment of high-risk, lymph node (LN)-positive, hormone receptor (HR)-positive breast cancer (BC). In a real-world setting the clinicopathologic features of patients potentially eligible for adjuvant abemaciclib remain to be defined. There are conflicting data regarding the biological behavior and long-term outcomes across invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). In our study we retrospectively assessed the real-world data and long-term outcome of selected high-risk features ILC compared to IDC, according to the MonarchE trial inclusion criteria. Methods: We identified 15,071 patients who got surgery at the European Institute of Oncology for a first primary, non-metastatic, HR-positive, HER2-negative BC from 2000 to 2008. 11,981 (79.5%) patients had an IDC and 1524 (10.1%) an ILC. The remaining 1566 patients (10.4%) had either combined ductal and lobular breast cancer or another histological breast cancer subtype. According to the eligibility criteria of the MonarchE study, we identified two high-risk groups, based on high number of positive lymph nodes, large tumor size, or a high cellular proliferation as measured by tumor grade or biomarkers. Patients were matched by propensity score. Findings: A total of 2872 (21.3%) patients were selected as clinically high-risk, including 361/1524 ILC (23.7%) and 2511/11,981 IDC (21%). 322 high-risk ILC were matched with similar high-risk IDC. The median follow-up was 13.2 years for survival. In the matched set, invasive disease-free survival (IDFS) (log-rank P = 0.09) and overall survival (OS) (log-rank P = 0.48) were not statistically significantly different between the two histological groups. For IDC patients, the 5-year and 10-year IDFS rates (95% CI) were 77.7% (72.9–82.2) and 57.3% (51.7–63.1) respectively, compared to the 5-year and 10-year IDFS rates of ILC patients that were 75.5% (70.6–80.2) and 50.7% (45.0–56.6). The 5-year and 10-year distant relapse free survival (DRFS) rates were 80% (75.3–84.2) and 65.3% (59.8–70.7) in IDC cohort, compared to the 5-year and the 10-year DRFS rates of 78.7% (74.0–83.1) and 61.5% (55.9–67.1) in the ILC cohort. Such data match the recent outcomes efficacy results of the MonarchE control arm. More patients in the ILC (n = 17) than in the IDC group (n = 10) developed axillary recurrence. At multivariable analysis, stratified for specific clinical features, age <35 years, pT2-3, axillary involvement with more than 10 positive axillary nodes were found to be predictors of unfavorable IDFS and OS in the overall matched high-risk population. Interpretation: Findings from this matched cohort study reported similar IDFS and DRFS rates for high risk HR positive early BC when compared to the control arm overall IDFS and DRFS rates reported from the MonarchE trial. Our study demonstrated rates of concordant long-term outcome status beyond histologic subtype. These data support an escalation strategy for these two different histological entities when diagnosed with high-risk features. In our dataset approximately 21% rate of high-risk HR positive early BC patients are potentially eligible for adjuvant abemaciclib treatment. Funding: Umberto Veronesi Foundation.http://www.sciencedirect.com/science/article/pii/S2589537024001317Invasive lobular breast cancerInvasive ductal breast cancerAbemaciclibMonarchE trialRecurrence |
| spellingShingle | Francesca Magnoni Giovanni Corso Patrick Maisonneuve Beatrice Bianchi Giuseppe Accardo Claudia Sangalli Giulia Massari Anna Rotili Luca Nicosia Filippo Pesapane Emilia Montagna Giovanni Mazzarol Viviana Galimberti Paolo Veronesi Giuseppe Curigliano Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context EClinicalMedicine Invasive lobular breast cancer Invasive ductal breast cancer Abemaciclib MonarchE trial Recurrence |
| title | Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context |
| title_full | Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context |
| title_fullStr | Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context |
| title_full_unstemmed | Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context |
| title_short | Comparison of long-term outcome between clinically high risk lobular versus ductal breast cancer: a propensity score matched studyResearch in context |
| title_sort | comparison of long term outcome between clinically high risk lobular versus ductal breast cancer a propensity score matched studyresearch in context |
| topic | Invasive lobular breast cancer Invasive ductal breast cancer Abemaciclib MonarchE trial Recurrence |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024001317 |
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