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Journal Title: 233P Real-world first-line (1L) treatment selection for Australian patients (pts) with hormone receptor-positive advanced breast cancer (HR+ ABC)
Authors: Wong, V.
Baron-Hay, S.E.
De Boer, R.H.
Boyle, F.
Collins, Ian M.
Cuff, K.
Gately, L.
Georgiou, C.L.
Greenberg, S.
Jude, E.
Karki, B.
Mok, K.
Morton, C.
Nottage, M.K.
Rainey, N.
Torres, J.
Tung, I.
Gibbs, P.
Lok, S.W.
SWH Author: Collins, Ian M.
Keywords: Breast Cancer
Issue Date: May-2024
Publisher: ESMO Open
Date Accessioned: 2024-05-27T00:25:06Z
Date Available: 2024-05-27T00:25:06Z
Abstract: Background CDK4/6 inhibitor (CDK4/6i) plus endocrine therapy (ET) is now standard 1L treatment for HR+ ABC. Whilst landmark trials demonstrate improvement in survival outcomes, real world treatment patterns and toxicities are limited. Methods ARORA, a multi-site Australian registry, captures real-world data on pts with HR+ ABC including baseline characteristics, systemic therapy sequencing and treatment outcomes. Consecutive pts diagnosed between Jan 2020 and Jan 2024 were enrolled. Results Data from 438 HR+ ABC pts with median follow up of 24.3 months were analysed. Median age was 64 yrs (IQR 54-74), with 64% ECOG 0-1 and 42% Charlson comorbidity index (CCI) ≥3. 44% of pts had visceral metastases and 19% had bone-only metastases at diagnosis. 60% of pts had relapsed disease at a median time of 7.0 yrs (IQR 4.2-10). Of relapsed pts, 10% and 48% received neoadjuvant and adjuvant chemotherapy (CT) respectively, and 79% received adjuvant ET. 41% relapsed on or within 12 months of stopping adjuvant ET. Of the 426 (97%) HR+ ABC pts who received 1L treatment, 77% had CDK4/6i + ET, 14% ET alone, 5% CT and 5% CT then ET +/- CDK 4/6i. CDK4/6i selection was 46% palbociclib (PA), 35% ribociclib (RI), 13% abemaciclib (AB). Compared to pts who received 1L CDK4/6i+ET, pts who received 1L ET alone were older (78.5 vs 63.0 yrs, p<0.01), with poorer performance status (ECOG ≥ 2 62% vs 30%, p<0.01) and more comorbidities (CCI ≥3 60% vs 37%, p<0.01), but with no difference in visceral metastases (42% vs 41%, p=0.99). Common CDK4/6i related toxicities were diarrhoea (PA 10% vs RI 12% vs AB 73%), neutropenia (PA 65% vs RI 47% vs AB 23%) and nausea/vomiting (PA 24% vs RI 47% vs AB 30%). 54% pts remain on 1L treatment, 27% and 21% have ceased due to progression and toxicity/pt preference respectively. Pts who received 1L CDK4/6i+ET had longer PFS than pts that received ET alone (30.4 vs 21.9 months, HR 0.58, p=0.02). Conclusions Reflecting international guidelines, the majority of routine care Australian HR+ ABC pts receive 1L CDK4/6i + ET. Pt factors such as age, ECOG and comorbidities appear to impact treatment selection. Real world CDK4/6i toxicity and early PFS data are similar to those reported in landmark clinical trials.
Type: Conference Paper
Conference Name: ESMO Breast Cancer 2024
ESMO Breast Cancer 2024
Conference Location: Berlin, Germany
Appears in Collections:SWH Staff Publications

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