title: Chemotherapy versus endocrine therapy as first-line treatment in patients with luminal-like HER2-negative metastatic breast cancer: A propensity score analysis.
abstract: BACKGROUND
  According to current guidelines, endocrine therapy (ET) is recommended as first-line treatment of luminal-like metastatic breast cancer (MBC), whereas chemotherapy (CT) should be considered in presence of life-threatening disease. In daily practice, CT is often used outside of this clinical circumstance. Factors influencing first-line choice and the relative impact on outcome are unknown.
  
  
  METHODS
  A consecutive series of luminal-like HER2-negative MBC patients treated from 2004 to 2014 was analyzed to test the association of disease- and patient-related factors with the choice of first-line treatment (ET vs. CT). A propensity score method was used to estimate impact of first-line strategy on outcome.
  
  
  RESULTS
  Of 604 consecutive luminal-like MBC patients identified, 158 cases were excluded due to unknown or positive HER2-status. Among 446 HER2-negative cases, 171 (38%) received first-line CT. On multivariate analysis, the only factors significantly associated with lower CT use were old age (OR 0.25, 95%C.I. 0.13-0.49) or presence of bone metastases only (OR 0.26, 95%C.I. 0.13-0.53). In propensity score matched population, no differences were observed between CT and ET as first-line treatment either in terms of overall survival (37.5 months and 33.4 months respectively, log-rank test, P = 0.62) or progression-free survival (13.3 months and 9.9 months respectively, log-rank test, P = 0.92).
  
  
  CONCLUSIONS
  High percentage of patients with luminal-like MBC received CT as first-line therapy in real-life. The choice was mainly driven by age and site of metastases. With the limitations of a non-randomized comparison, no differences on patients' outcome were observed depending on the first-line strategy.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy. Electronic address: bonottomarta@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Bonotto
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gerratana
authors.affiliation: Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (TO), Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: De Angelis
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Marika
authors.initials: M
authors.lastname: Cinausero
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Moroso
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Milano
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Brigida
authors.initials: B
authors.lastname: Stanzione
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Gargiulo
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Iacono
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Alessandro Marco
authors.initials: AM
authors.lastname: Minisini
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Mansutti
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: De Placido
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Arpino
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Puglisi
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D057216:Propensity Score; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D006727:Hormone Antagonists; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Chemotherapy; Decision making; Drug therapy; Metastatic breast neoplasms; Treatment outcome