title: A prognostic factor index for overall survival in patients receiving first-line chemotherapy for HER2-negative advanced breast cancer: an analysis of the ATHENA trial.
abstract: BACKGROUND
  Evidence-based definitions of 'poor-prognosis' or 'aggressive' advanced breast cancer are lacking.
  
  
  METHODS
  We developed a prognostic factor index using data from 2203 patients treated with first-line chemotherapy plus bevacizumab for HER2-negative advanced breast cancer.
  
  
  RESULTS
  The risk factors most closely associated with worse OS were: disease-free interval ≤24 months; liver metastases or ≥3 involved organ sites; prior anthracycline and/or taxane therapy; triple-negative breast cancer (TNBC); and performance status 2 or prior analgesic/corticosteroid treatment. Risk of death was increased threefold in patients with ≥3 versus ≤1 risk factors (hazard ratio 3.0 [95% CI 2.6-3.4; p < 0.001]; median 16.0 vs 38.8 months, respectively).
  
  
  CONCLUSIONS
  This prognostic index may enable identification of patients with a poorer prognosis in whom more intensive systemic regimens may be appropriate. The index may also be considered in designing new trials, although it requires validation in other datasets before extrapolation to non-bevacizumab-containing therapy. ClinicalTrials.gov identifier: NCT00448591.
authors.affiliation: Medica Scientia Innovation Research (MedSIR ARO), Barcelona, Spain; Hospital Arnau de Vilanova de Valencia, Valencia, Spain. Electronic address: antonio.llombart@medsir.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Llombart-Cussac
authors.affiliation: Institut Regional du Cancer en Franche-Comté, Centre Hospitalier Universitaire de Besançon, Besançon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pivot
authors.affiliation: Sandro Pitigliani Medical Oncology Department, Nuovo Ospedale di Prato, Istituto Toscano Tumori, Prato, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Biganzoli
authors.affiliation: University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Hernan
authors.initials: H
authors.lastname: Cortes-Funes
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Kathleen I
authors.initials: KI
authors.lastname: Pritchard
authors.affiliation: Institut Curie, Université Paris Descartes, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.affiliation: Royal Marsden Hospital and The Institute of Cancer Research, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Department of Gynaecology, Martin-Luther-Universität Halle-Wittenberg, Halle an der Saale, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomssen
authors.affiliation: F Hoffmann-La Roche Ltd, Basel, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Srock
authors.affiliation: Medica Scientia Innovation Research (MedSIR ARO), Barcelona, Spain; Scienco Klinico, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Sampayo
authors.affiliation: Medica Scientia Innovation Research (MedSIR ARO), Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Cortes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; C508053:ERBB2 protein, human
keywords: Bevacizumab; Metastatic breast cancer; Overall survival; Prognostic factor; Risk factor; Triple-negative breast cancer