A. Gonçalves (Marseille, France)

Institute Paoli-Calmettes

Author Of 2 Presentations

 On-Demand ePoster Display

50P - Early breast cancer in women aged 35 years or younger: a French population-based case control-matched analysis

Abstract

Background

There is a scarcity of data exploring prognostic factors in young patients with breast cancer (BC), and the independent negative impact of age by itself is still debated. We aimed to assess shared and intrinsic prognostic factors in a large cohort of patients aged 35 years or younger, compared to a control group aged from 36 to 50.

Methods

Patients ≤50 years old were retrospectively identified from a large cohort of 23 134 early BC patients who underwent primary surgery in 18 academic centers between 1990 and 2014. Multivariate Cox analysis aiming to identify factors associated with disease-free and overall survival (DFS and OS) were built for the total cohort, and then for the ≤35 years cohort only. To further assess the independent impact of age on DFS and OS, 1 to 3 case control analysis was performed by matching ≤35 and 36 to 50 according to histology, grade, tumor size, lymphovascular invasion (LVI), nodal status, endocrine receptors (ER), endocrine therapy (ET) and chemotherapy (CT).

Results

On 6 481 patients included, 556 were aged ≤35 years, and 5 925 from 36 to 50. Compared to the 36-50 group, age ≤35 was significantly associated with larger tumors, higher grade, ER negativity, macroscopic lymph node involvement, LVI, and higher rates of mastectomy and chemotherapy use. In multivariate analysis, age ≤35 was associated with worse DFS (HR 1.59, 95% CI 1.35-1.88; p<0.001), and OS (HR 1.32, 95% CI 1.06-1.64; p=0.014), as were high grade, large tumor size, LVI, macroscopic lymph node involvement, ER negativity, and absence of ET or CT. Adverse prognostic impact of age ≤35 was maintained in the case control-matched analysis for DFS (HR 1.56, 95%CI 1.28-1.91, p<0.001), and OS (HR 1.33, 95%CI 1.02-1.73, p=0.032). When considering patients ≤35 for multivariate analysis, only ER, tumor size, lymph node involvement and LVI remained statistically significantly associated with OS and DFS.

Conclusions

An age ≤35 years is associated with less favorable features at BC diagnosis, and more aggressive treatment strategies. Our results support the poor prognosis value of young age, which independently persisted when adjusting for other prognostic factors and treatments, as well as in the control-matched analysis.

Legal entity responsible for the study

Institut Paoli-Calmettes.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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102P - Breast cancer patients treated with intrathecal therapy for leptomeningeal metastases: characteristics and validation of prognostic models in a large real-life database

Abstract

Background

Leptomeningeal metastasis (LM) is a rare complication of metastatic breast cancer (MBC), with high rates of morbidity/mortality. Large cohorts are scarce. Our study aimed to describe the largest-to-date real-life population of MBC patients treated with intrathecal (IT) therapy and to evaluate prognostic models.

Methods

ESME MBC database (NCT03275311) includes all consecutive patients having started treatment for MBC since 2008. Overall survival (OS) of patients treated with IT therapy was estimated using the Kaplan-Meier method. Prognostic models were constructed using Cox proportional hazards models. Performance was evaluated using C-index and calibration plots.

Results

Of 22,266 female patients included in the ESME database covering 2008-2016, 312 were IT-treated with methotrexate, cytarabine or thiotepa and included in our analysis (15 patients have been excluded because of lack of data on the treatment line). Compared with non-IT treated ones, these were younger at MBC relapse (median age 52 years vs 61 years) and had more often lobular histology (23.4% vs 12.7%) or triple-negative subtype (24.7% vs 13.3%) (all p<0.001). Median OS was 4.5 months (95% CI 3.8-5.6) and 1-year survival rate was 25.6%. In case of IT therapy, significant prognostic factors associated with worse outcome by multivariable analysis were triple-negative subtype (HR=1.81 [95%CI 1.32-2.47]), treatment line ≥ 3 (HR=1.88 [95% CI 1.30-2.73]), ≥ 3 other metastatic sites (HR=1.33 [95%CI 1.01-1.74]), and IT cytarabine or thiotepa vs methotrexate (HR=1.68 [95%CI 1.28-2.22]), while concomitant systemic therapy was associated with better OS (HR=0.47 [95%CI 0.35-0.62]) (all p<0.001). We validated two previously published prognostic scores, the Curie score and the breast graded prognostic assessment, both with C-index of 0.57.

Conclusions

MBC patients with LM treated with IT therapy have a poor prognosis. However, in this large series, we could identify a subgroup of patients with better prognosis, when concomitant systemic therapy and IT methotrexate were used.

Clinical trial identification

NCT03275311.

Legal entity responsible for the study

UNICANCER.

Funding

UNICANCER. The ESME MBC database receives financial support from an industrial consortium (Roche, Pfizer, AstraZeneca, MSD, Eisai and Daiichi Sankyo). Data collection, analysis and publication are managed entirely by R&D UNICANCER independently of the industrial consortium.

Disclosure

M. Campone: Honoraria (self): Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis; Advisory/Consultancy: GT1. All other authors have declared no conflicts of interest.

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