title: Hormonal therapy followed by chemotherapy or the reverse sequence as first-line treatment of hormone-responsive, human epidermal growth factor receptor-2 negative metastatic breast cancer patients: results of an observational study.
abstract: Introduction Although hormonal-therapy is the preferred first-line treatment for hormone-responsive, HER2 negative metastatic breast cancer, no data from clinical trials support the choice between hormonal-therapy and chemotherapy.Methods Patients were divided into two groups according to the treatment: chemotherapy or hormonal-therapy. Outcomes in terms of clinical benefit and median overall survival (OS) were retrospectively evaluated in the two groups. To calculate the time spent in chemotherapy with respect to OS in the two groups, the proportion of patients in chemotherapy relative to those present in either group was computed at every day from the start of therapy.Results From 1999 to 2013, 119 patients received first-line hormonal-therapy (HT-first group) and 100 first-line chemotherapy (CT-first group). Patients in the CT-first group were younger and with poorer prognostic factors as compared to those in HT-first group. Clinical benefit (77 vs 81%) and median OS (50.7 vs 51.1 months) were similar in the two groups. Time spent in chemotherapy was significantly longer during the first 3 years in CT-first group (54-34%) as compared to the HT-first group (11-18%). This difference decreased after the third year and overall was 28% in the CT-first group and 18% in the HT-first group.Conclusions The sequence first-line chemotherapy followed by hormonal-therapy, as compared with the opposite sequence, is associated with a longer time of OS spent in chemotherapy. However, despite the poorer prognostic factors, patients in the CT-first group had a superimposable OS than those in the HT-first group.
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bighin
authors.affiliation: Department of Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Dozin
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Poggio
authors.affiliation: Department of Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceppi
authors.affiliation: Department of Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: D'Alonzo
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Levaggi
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Giraudi
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lambertini
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Miglietta
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Vaglica
authors.affiliation: Department of Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fontana
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Iacono
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pronzato
authors.affiliation: Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Mastro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D064887:Observational Studies as Topic; D016017:Odds Ratio; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases
keywords: advanced breast cancer; chemotherapy; first-line treatment; hormonal therapy; hormone-responsive breast cancer