Endocrine therapy is the preferred treatment for patients with hormone receptor (HR)-positive metastatic breast cancer (MBC). While visceral metastasis is a negative prognostic factor, few studies have distinguished between the prognoses of metastases at different visceral sites.
In total, 398 patients receiving fulvestrant 500 mg at a single center over a 6-year period were analyzed. Logistic regression models identified the prognostic factors associated with progression-free survival (PFS). Kaplan-Meier analysis compared the PFS of patients with lung and liver metastases.
Baseline visceral metastases were present in 233 patients, including 138 with lungw/o liver metastases (lung metastases without liver involvement), 51 with liverw/o lung metastases (liver metastases without lung involvement) and 41 with lung and liver metastases. The median PFS was 6.8 months (5.6 and 9.2 months for visceral and nonvisceral metastases, respectively, P = 0.028). Patients with lungw/o liver metastases had longer PFS than those with liverw/o lung metastases or lung and liver metastases (9.6, 3.7 and 3.2 months, respectively, P < 0.001; liverw/o lung versus lungw/o liver hazard ratio (HR) 1.70; lung and liver versus lungw/o liver HR 2.85). Patients with liver metastases experienced significantly worse PFS than those without liver involvement (3.7 versus 9.2 months, P < 0.001). PFS benefits were observed in patients with longer disease-free intervals, no liver metastases, and no previous chemotherapy.
Fulvestrant treatment benefitted patients with lungw/o liver or nonvisceral metastases. It is important to differentiate liver from lung metastases when treating HR-positive/HER2-negative MBC with endocrine therapy.
Fudan University Shanghai Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.