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DOI: 10.1055/a-2286-5372
Attrition in the First Three Therapy Lines in Patients with Advanced Breast Cancer in the German Real-World PRAEGNANT Registry
Real-World-Daten des deutschen PRAEGNANT-Registers zu Therapieabbrüchen der ersten 3 Therapielinien bei Patientinnen mit fortgeschrittenem BrustkrebsAuthors
Abstract
Background With more effective therapies for patients with advanced breast cancer (aBC), therapy sequences are becoming increasingly important. However, some patients might drop out of the treatment sequence due to deterioration of their life status. Since little is known about attrition in the real-world setting, this study assessed attrition in the first three therapy lines using a real-world registry.
Methods Patients with information available on the first three therapy lines were selected from the German PRAEGNANT registry (NCT02338167). Attrition was determined for each therapy line using competing risk analyses, with the start of the next therapy line or death as endpoints. Additionally, a simple attrition rate was calculated based on the proportion of patients who completed therapy but did not start the next therapy line.
Results Competitive risk analyses were performed on 3988 1st line, 2651 2nd line and 1866 3rd line patients. The probabilities of not starting the next therapy line within 5 years after initiation of 1st, 2nd and 3rd line therapy were 30%, 24% and 24% respectively. Patients with HER2-positive disease had the highest risk for attrition, while patients with HRpos/HER2neg disease had the lowest risk. Attrition rates remained similar across molecular subgroups in the different therapy lines.
Conclusion Attrition affects a large proportion of patients with aBC, which should be considered when planning novel therapy concepts that specifically address the sequencing of therapies. Taking attrition into account could help understand treatment effects resulting from sequential therapies and might help develop treatment strategies that specifically aim at maintaining quality of life.
Zusammenfassung
Hintergrund Therapien zur Behandlung von fortgeschrittenem Brustkreb sind zunehmend effektiver geworden. Dies bedeutet auch, dass Therapiesequenzen immer wichtiger werden. Manche Patientinnen brechen aber eine Therapiesequenz wegen der Verschlechterung der Lebensqualität ab. Es gibt nur wenige Real-World-Daten zum Problem des Therapieabbruchs. Diese Studie untersucht Therapieabbrüche für die ersten 3 Therapielinien in einem Register mit Real-World-Daten.
Methoden Es wurden Patientinnen ausgewählt, für die Informationen im deutschen PRAEGNANT-Register zu den ersten 3 Therapielinien (NCT02338167) vorlagen. Die Therapieabbruchraten für jede Therapielinie wurde bestimmt mithilfe konkurrierender Risikoanalysen. Endpunkte waren der Beginn der nächsten Therapielinie oder der Tod. Es wurde auch eine einfache Abbruchrate berechnet, die auf den Prozensatz der Patientinnen beruhte, die eine Therapielinie abgeschlossen hatten, aber die nächste Therapielinie nicht anfingen.
Ergebnisse Konkurrierende Risikoanalysen wurden für 3988 Erstlinientherapie-Patientinnen, 2651 Zweitlinientherapie-Patientinnen und 1866 Drittlinientherapie-Patientinnen durchgeführt. Die Wahrscheinlichkeiten, dass Patientinnen die nächste Therapielinie nicht innerhalb von 5 Jahren nach Beginn der Erstlinien-, Zweitlinien- oder Drittlinientherapie begannen, betrugen jeweils 30%, 24% bzw. 24%. Das höchste Abbruchrisiko hatten Patientinnen mit HER2+ Erkrankung, wohingegen das Abbruchrisiko bei Patientinnen mit HR+/HER2− Brustkrebs am niedrigsten war. Die Abbruchraten waren in den verschiedenen Therapielinien über alle molekularen Subgruppen hinweg ähnlich.
Schlussfolgerung Therapieabbruch betrifft eine Vielzahl von Patientinnen mit fortgeschrittenem Brustkrebs. Dies sollte bei der Planung von neuartigen Therapiekonzepten, die speziell die Sequenzierung von Therapien zum Fokus haben, beachtet werden. Die Berücksichtigung von Therapieabbrüche könnte zu einem besseren Verständnis der Auswirkungen von sequenziellen Therapien führen und bei der Entwicklung von Behandlungsstrategien helfen, die konkret das Ziel haben, die Lebensqualität aufrechtzuhalten.
Keywords
advanced breast cancer - de novo metastatic breast cancer - recurrent breast cancer metastases - clinical trialsSchlüsselwörter
fortgeschrittener Brustkrebs - de novo metastasierter Brustkrebs - Brustkrebsrezidiv mit Metastasen - klinische StudienSupplementary Material
- Supporting Information (PDF)
Supplementary Tables
• Supplementary Table S1: Data categories recorded in the PRAEGNANT study.
• Supplementary Table S2: Patient characteristics according to molecular subtype in the 1st therapy line.
• Supplementary Table S3: Patient characteristics according to molecular subtype in the 2nd therapy line.
• Supplementary Table S4: Patient characteristics according to molecular subtype in the 3rd therapy line.
• Supplementary Table S5: Simple attrition rates for patients who completed the 1st therapy line according to patient/tumor characteristics.
• Supplementary Table S6: Simple attrition rates for patients who completed the 2nd therapy line according to patient/tumor characteristics.
• Supplementary Table S7: Simple attrition rates for patients who completed the 3rd therapy line according
to patient/tumor characteristics.
Supplementary Figures
• Supplementary Fig. S1: Patient flow chart for the patient populations in the first line: Population 1CR, population 1ATR. CR: competing risk, ATR: simple attrition population.
• Supplementary Fig. S2: Patient flow chart for the patient population in the second line: Population 2CR, and population 2ATR. CR: competing risk, ATR: simple attrition population.
• Supplementary Fig. S3: Patient flow chart for the patient population in the third line: Population 3CR, and population 3ATR. CR: competing risk, ATR: simple attrition population.
Publication History
Received: 10 January 2024
Accepted: 12 March 2024
Article published online:
29 May 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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