Metastatic Behaviors And Treatment Strategies Of Hormone Receptor Positive And Human Epidermal Growth Factor Receptor-2 Negative Breast Cancer

Background:The peak hazard of recurrence of breast cancer occurs in the interval of 2-3 years after diagnosis(early recurrence). Unlike in other breast cancer subtypes, more than half of all disease recurrences in hormone receptor positive and human epidermal receptor negative(HR+/HER2-) breast cancer occur 5 years or later after diagnosis, particularly following 5 years of adjuvant anti-estrogen therapy, which is called late recurrence, and the mortality rates were constant over time.Objective:To compare the clinicopathological features and prognosis of early and late recurrence in HR+/HER2-breast cancer patients.Materials and methods:We collected the clinical data of recurrent breast cancer patients who previously received operation in Cancer Institute and Hospital. Chinese Academy of Medical Sciences between 2003 and 2009.Among them,a total of 390 HR+/HER2-eligible patients were involved.279 got relapse within 5years after diagnosis (early recurrence), and 111 patients got late recurrence. Clinicopathological features and the sites of the initial metastasis and the differences of the survival after recurrence were compared between the two groups.Results:Patients with vascular invasion.>4 lymph node metastases were found more common in early recurrences(P<0.05).while double hormone receptor positive (ER+/PgR+). non standardized endocrine therapy were seen more frequently in patients with late recurrences (P<0.05).In the late recurrent group, the proportion of lung metastasis was 47.7%, which was significantly higher than that(25.1%) in early recurrence group (P<0.001). Although visceral and multiple-organ (P<O.05) metastasis were more common in late recurrent group, but the median overall survival (OS) after recurrence of it was 66 months, which was significantly longer than that in early recurrence group(39 months.HR.1.6, P=0.003).Conclusion:HER2 negative luminal type breast cancer with early recurrence and late recurrence showed multiple differences in clinicopathological characteristics and outcomes.Vascular invasion,>4 lymph node metastases were more frequently seen in early recurrence, both of which were factors associated with DFS (disease free survival).Double hormone receptor positive, non standardized endocrine therapy occupied a higher rate in patients with late recurrence.Late recurrence seemed to be a common recurrence patterns in HER2 negative luminal type breast cancer patients,which possessed a better prognosis as well.Background:Both hormonal therapy (HT) and maintenance capecitabine monotherapy (MCT) have been shown to extend time to progression (TTP) in patients with metastatic breast cancer (MBC) after failure of taxanes and anthracycline-containing regimens. However, no clinical trials have directly compared the efficacy of MCT and HT after response to first-line capecitabine-based combination chemotherapy (FCCT) in patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer.Methods:We retrospectively analyzed the charts of 138 HR-positive and HER2-negative MBC patients who were in non-progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, in Beijing, China. The median number of first-line chemotherapy cycles was 6 (range,4-8); combined agents included taxanes, vinorelbine, or gemcitabine. Of these 138 patients,79 received MCT, and 59 received HT. Single-agent capecitabine was administered at a dose of 1250 mg/m2 twice daily for 14 days, followed by a 7-day rest period, repeated every 3 weeks. Of the 59 patients who received HT,37 received aromatase inhibitors (AIs),8 received selective estrogen receptor modulators (SERMs), and 14 received goserelin plus either AIs or SERMs. We then compared the MCT group and HT group in terms of treatment efficacy.Results:With a median follow-up of 43 months, patients in the HT group had a much longer TTP than patients in the MCT group (13 months vs.8 months, P= 0.011). When TTP was adjusted for age, menopausal status, Karnofsky performance status (KPS) score, disease-free survival, site of metastasis, number of metastatic sites, and response status after FCCT, extended TTP was still observed for patients in the HT group (hazard ratio: 0.63; 95% confidence interval:0.44-0.93; P= 0.020). We also observed a trend of overall survival (OS) advantage for patients in the HT group versus patients in the MCT group, but the difference was not significant (43 months vs.37 months, P= 0.400). In addition, patients in the HT group generally tolerated the treatment well, whereas patients in the MCT group experienced grades 3—4 adverse events, the most frequent of which were hand-foot syndrome (15.8%) and hematologic abnormalities (7.6%).Conclusion:For HR-positive and HER2-negative MBC patients, HT might be considered a treatment after response to FCCT but prior to MCT as a long-term administration.