title: In real life, one-quarter of patients with hormone receptor-positive metastatic breast cancer receive chemotherapy as initial palliative therapy: a study of the Southeast Netherlands Breast Cancer Consortium.
abstract: BACKGROUND
  The objective of this study was to present initial systemic treatment choices and the outcome of hormone receptor-positive (HR+) metastatic breast cancer.
  
  
  METHODS
  All the 815 consecutive patients diagnosed with metastatic breast cancer in 2007-2009 in eight participating hospitals were identified. From the 611 patients with HR+ disease, a total of 520 patients with HER2-negative (HER2-) breast cancer were included. Initial palliative systemic treatment was registered. Progression-free survival (PFS) and overall survival (OS) per initial palliative systemic therapy were obtained using the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  From the total of 520 patients with HR+/HER2- metastatic breast cancer, 482 patients (93%) received any palliative systemic therapy. Patients that received initial chemotherapy (n = 116) were significantly younger, had less comorbidity, had received more prior adjuvant systemic therapy and were less likely to have bone metastasis only compared with patients that received initial endocrine therapy (n = 366). Median PFS of initial palliative chemotherapy was 5.3 months [95% confidence interval (CI) 4.2-6.2] and of initial endocrine therapy 13.3 months (95% CI 11.3-15.5), with a median OS of 16.1 and 36.9 months, respectively. Initial chemotherapy was also associated with worse outcome in terms of PFS and OS after adjustment for prognostic factors.
  
  
  CONCLUSIONS
  A high percentage of patients with HR+ disease received initial palliative chemotherapy, which was associated with worse outcome, even after adjustment of relevant prognostic factors.
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht Department of Internal Medicine, Máxima Medical Center, Veldhoven.
authors.forename: D J A
authors.initials: DJ
authors.lastname: Lobbezoo
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht.
authors.forename: R J W
authors.initials: RJ
authors.lastname: van Kampen
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht Netherlands Comprehensive Cancer Organisation, Utrecht.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Internal Medicine, Máxima Medical Center, Veldhoven.
authors.forename: M W
authors.initials: MW
authors.lastname: Dercksen
authors.affiliation: Department of Internal Medicine, Atrium-Orbis Heerlen, Heerlen.
authors.forename: F
authors.initials: F
authors.lastname: van den Berkmortel
authors.affiliation: Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch.
authors.forename: T J
authors.initials: TJ
authors.lastname: Smilde
authors.affiliation: Department of Internal Medicine, VieCuri Medical Center, Venlo.
authors.forename: A J
authors.initials: AJ
authors.lastname: van de Wouw
authors.affiliation: Department of Internal Medicine, Atrium-Orbis Sittard, Sittard.
authors.forename: F P J
authors.initials: FP
authors.lastname: Peters
authors.affiliation: Department of Internal Medicine, St Elisabeth Hospital, Tilburg.
authors.forename: J M G H
authors.initials: JM
authors.lastname: van Riel
authors.affiliation: Department of Internal Medicine, St Jans Hospital, Weert.
authors.forename: N A J B
authors.initials: NA
authors.lastname: Peters
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht.
authors.forename: M
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P G M
authors.initials: PG
authors.lastname: Peer
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht vcg.tjan.heijnen@mumc.nl.
authors.forename: V C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D010166:Palliative Care / Q000379:methods*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: chemotherapy; endocrine therapy; hormone receptor; metastatic breast cancer; outcome