title: Treatment patterns and duration in post-menopausal women with HR+/HER2- metastatic breast cancer in the US: a retrospective chart review in community oncology practices (2004-2010).
abstract: BACKGROUND
  Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines.
  
  
  OBJECTIVE
  To describe treatment patterns and treatment durations by lines of therapy for ET and CT among post-menopausal HR+/HER2- mBC patients.
  
  
  METHODS
  Charts were reviewed from a network of community-based oncology practices of eligible patients who had progressed after initiating adjuvant or first-line treatment for mBC between 1 January 2004 and 30 September 2010. Extracted chart data included demographics, treatment histories, and outcomes. Treatment duration was estimated using Kaplan-Meier estimators.
  
  
  RESULTS
  A total of 144 patients were studied. Patients received a median of two lines of ET, and <10% had three or more lines of ET before receiving CT. From first line to second line, the median treatment duration was 11.6 to 4.9 months for ET overall; 13.8 to 10.5 months for anastrozole; 18.6 to 7.0 months for letrozole; and 5.1 to 2.9 months for fulvestrant. For CT, the median duration was 5.1 months in the first line and 3.7 months and below in subsequent lines.
  
  
  CONCLUSIONS
  During the study period (1 January 2004 - 30 September 2012), most patients received <3 lines of ET before receiving CT. The drop in median duration of ET from first to second line suggests that single agent ETs might not be as effective beyond the first line. A key limitation of this study was the small sample size. In addition, more research is needed to further investigate the short treatment duration of fulvestrant across early lines of therapy (which could indicate lack of efficacy).
authors.affiliation: Analysis Group Inc. , Boston, MA , USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Macalalad
authors.forename: Yanni
authors.initials: Y
authors.lastname: Hao
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Lin
authors.forename: James E
authors.initials: JE
authors.lastname: Signorovitch
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Erika
authors.initials: E
authors.lastname: Ohashi
authors.forename: Zhou
authors.initials: Z
authors.lastname: Zhou
authors.forename: Caroline
authors.initials: C
authors.lastname: Kelley
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D024221:Antineoplastic Protocols; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care; D017698:Postmenopause; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Chemotherapy; Endocrine therapy; HR+/HER2-; Metastatic breast cancer; Post-menopausal; Treatment duration; Treatment patterns