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Epidemiological characteristics, clinical outcomes and management patterns of metastatic breast cancer patients in routine clinical care settings of Greece: Results from the EMERGE multicenter retrospective chart review study

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      Abstract

      Background

      The “EMERGE” study, aimed to capture real-life management patterns and outcomes in metastatic breast cancer (MBC) in Greece, also accounting for hormone (HR) and human epidermal growth factor receptor 2 (HER2) status.

      Methods

      “EMERGE” was a multicenter, retrospective cohort study of adult MBC patients diagnosed between 01-Janaury-2010 and 30-June-2012, either de novo or having progressed from a non-metastatic state. Patient data, including treatment patterns and outcomes, were mainly abstracted through medical chart review.

      Results

      386 patients were enrolled by 16 hospital-based oncologists between 12-March-2013 and 31-March-2015. The median look-back period was 29.1 months. At MBC diagnosis, 56.1% of the patients were HR +/HER2 , 16.6% HR +/HER2 +, 14.5% HR /HER2 , and 12.8% HR /HER2 +. In the first line setting, chemotherapy, targeted therapy and endocrine therapy were received by 76.7, 52.4, and 28.3% of the overall population, and by 66.5/36.2/42.0%, 80.4/80.4/28.6%, 88.4/90.7/0.0, and 95.6%/56.5/6.5% of the HR +/HER2 , HR +/HER2 +, HR /HER2 +, HR /HER2 subpopulations, respectively. In the overall population, the disease progression incidence rate was 0.57 [95% confidence interval (CI): 0.48–0.67] per person-year; median progression-free survival (PFS) was 22.4 (95% CI: 20.4–24.7) and overall survival (OS) was 45.0 (95% CI: 40.9–55.0) months. Median PFS was 24.6 (95% CI: 21.3–27.9) in HR +/HER2 , 19.7 (95% CI: 12.9–25.9) in HR +/HER2 +, 23.0 (95% CI: 16.6–29.7) in HR /HER2 + and 18.3 (95% CI: 10.0–24.7) months in HR /HER2 subpopulations. A multivariable Cox proportional hazards model, adjusted among other factors for age and duration of diagnosis, HR and HER2 status, demonstrated that in the overall population PFS was better among those receiving first line endocrine therapy (hazard ratio: 0.70; 95%CI: 0.51–0.95; p = 0.024).

      Conclusions

      “EMERGE” demonstrates differences between HR/HER2 subtypes in clinical outcomes and divergence from evidence-based guideline recommendations for MBC management, especially as it pertains to the HR +/HER2 patients in which chemotherapy was favored over endocrine therapy in the first line setting.

      Study registration

      The study has been registered on the electronic Registry of Non-Interventional Studies (RNIS) posted on the website of the Hellenic Association of Pharmaceutical Companies (SFEE): https://www.dilon.sfee.gr/studiesp_d.php?meleti_id=NIS-OGR-XXX-2012/1

      Related collections

      Most cited references 24

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      Nonparametric Estimation from Incomplete Observations

       E. Kaplan,  Paul Meier (1958)
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        Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012.

        Cancer incidence and mortality estimates for 25 cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for the European Union (EU-27) for 2012. We used statistical models to estimate national incidence and mortality rates in 2012 from recently-published data, predicting incidence and mortality rates for the year 2012 from recent trends, wherever possible. The estimated rates in 2012 were applied to the corresponding population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2012. There were an estimated 3.45 million new cases of cancer (excluding non-melanoma skin cancer) and 1.75 million deaths from cancer in Europe in 2012. The most common cancer sites were cancers of the female breast (464,000 cases), followed by colorectal (447,000), prostate (417,000) and lung (410,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (353,000 deaths), colorectal (215,000), breast (131,000) and stomach (107,000). In the European Union, the estimated numbers of new cases of cancer were approximately 1.4 million in males and 1.2 million in females, and around 707,000 men and 555,000 women died from cancer in the same year. These up-to-date estimates of the cancer burden in Europe alongside the description of the varying distribution of common cancers at both the regional and country level provide a basis for establishing priorities to cancer control actions in Europe. The important role of cancer registries in disease surveillance and in planning and evaluating national cancer plans is becoming increasingly recognised, but needs to be further advocated. The estimates and software tools for further analysis (EUCAN 2012) are available online as part of the European Cancer Observatory (ECO) (http://eco.iarc.fr). Copyright © 2013 Elsevier Ltd. All rights reserved.
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          Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015

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            Author and article information

            Affiliations
            [1 ]GRID grid.412481.a, Department of Medical Oncology, , University General Hospital of Heraklion Crete Voutes, ; 711 10, Iraklio, Greece
            [2 ]1st Department of Medical Oncology, Agios Savvas Anticancer Hospital, 171 Alexandras Av, 115 22 Athens, Greece
            [3 ]2nd Department of Medical Oncology, Agios Savvas Anticancer Hospital, 171 Alexandras Av, 115 22 Athens, Greece
            [4 ]GRID grid.470050.6, 3rd Department of Medical Oncology, , Agii Anargiri Cancer Hospital, ; Kaliftaki 145, 14564 N. Kifissia, Athens, Greece
            [5 ]ISNI 0000 0004 0622 4662, GRID grid.411449.d, Medical Oncology Unit, , ATTIKON University Hospital, ; 1 Rimini St, 124 62 Athens, Greece
            [6 ]GRID grid.413862.a, Oncology Unit, 2nd Department of Surgery, , Aretaieion Hospital, ; 76 Vas. Sofias Av, 115 28 Athens, Greece
            Contributors
            kotsakis@med.uoc.gr
            ardavanis@yahoo.com
            gkoumak@otenet.gr
            epsam@otenet.gr
            psyrri237@yahoo.com
            ORCID: http://orcid.org/0000-0001-8084-0445, +30 210 7286305 , +30 697 4441501 , chr_papadim@yahoo.gr
            Journal
            BMC Cancer
            BMC Cancer
            BMC Cancer
            BioMed Central (London )
            1471-2407
            18 January 2019
            18 January 2019
            2019
            : 19
            30658600 6339387 5301 10.1186/s12885-019-5301-5
            © The Author(s). 2019

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: AstraZeneca Greece(GR)
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2019

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