Prior Treatment Time Affects Survival Outcomes in Metastatic Breast Cancer

Gabrielle B Rocque; Aidan Gilbert; Courtney P Williams; Kelly M Kenzik; Arie Nakhmani; Pravinkumar G Kandhare; Smita Bhatia; Mark E Burkard; Andres Azuero

doi:10.1200/CCI.20.00008

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Prior Treatment Time Affects Survival Outcomes in Metastatic Breast Cancer

Journal article

Open access

Peer reviewed

Prior Treatment Time Affects Survival Outcomes in Metastatic Breast Cancer

Gabrielle B Rocque, Aidan Gilbert, Courtney P Williams, Kelly M Kenzik, Arie Nakhmani, Pravinkumar G Kandhare, Smita Bhatia, Mark E Burkard and Andres Azuero

JCO clinical cancer informatics, Vol.4(4), pp.500-513

06/01/2020

DOI: 10.1200/CCI.20.00008

PMCID: PMC7444642

PMID: 32479187

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Abstract

Sequential drug treatments in metastatic breast cancer (MBC) are disparate. Clinical trial data includes limited reporting of treatment context, primarily including the number of prior therapies. This study evaluates the relationship between prior treatment time, prior lines of treatment, and survival using a novel visualization technique coupled with statistical analyses. This retrospective cohort study used a nationwide, de-identified electronic health record-derived database to identify women with hormone receptor-positive, human epidermal growth factor receptor 2-negative MBC diagnosed in 2014 who subsequently received paclitaxel. Images were created, with individual patients represented on the -axis and time, on the -axis. Specific treatments were represented by colored bars, with Kaplan-Meier curves overlaying the image. Separate images assessed progression-free survival and overall survival (OS). Hazard ratios (HRs) and 95% CIs from Cox proportional hazards models evaluated the association between prior treatment time and OS. Of 234 patients, median survival from first paclitaxel administration was 20 months (interquartile range, 8-53 months). An inverse relationship was observed between OS after paclitaxel and timing of administration. In adjusted models, each year on treatment prior to paclitaxel was associated with a 16% increased hazard of death after paclitaxel (HR, 1.16; 95% CI, 1.05 to 1.29). OS after a specific treatment is dependent on when a drug is given in the disease context, highlighting the potential for an overall OS benefit to be observed on the basis of treatment timing. Prior time on treatment should be considered as a stratifying factor in randomized trials and a confounding factor when examining survival in observational data.

Antineoplastic Combined Chemotherapy Protocols

Breast Neoplasms - drug therapy

Disease-Free Survival

Female

Humans

Receptor, ErbB-2 - therapeutic use

Retrospective Studies

Details

Title: Subtitle: Prior Treatment Time Affects Survival Outcomes in Metastatic Breast Cancer
Creators: Gabrielle B Rocque - Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
Aidan Gilbert - Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
Courtney P Williams - Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
Kelly M Kenzik - Institute for Cancer Outcomes and Survivorship, UAB, Birmingham, AL
Arie Nakhmani - Department of Electrical and Computer Engineering, UAB, Birmingham, AL
Pravinkumar G Kandhare - Department of Electrical and Computer Engineering, UAB, Birmingham, AL
Smita Bhatia - Institute for Cancer Outcomes and Survivorship, UAB, Birmingham, AL
Mark E Burkard - University of Wisconsin–Madison
Andres Azuero - School of Nursing, UAB, Birmingham, AL
Resource Type: Journal article
Publication Details: JCO clinical cancer informatics, Vol.4(4), pp.500-513
DOI: 10.1200/CCI.20.00008
PMID: 32479187
PMCID: PMC7444642
NLM abbreviation: JCO Clin Cancer Inform
ISSN: 2473-4276
eISSN: 2473-4276
Language: English
Date published: 06/01/2020
Academic Unit: Internal Medicine
Record Identifier: 9984700650302771

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