Background
Hormone receptor (HR)-positive, HER2-negative metastatic invasive lobular breast cancer (mILC) is distinct from invasive ductal cancer (IDC) in clinicopathologic and molecular characteristics, impacting its response to systemic therapy. While endocrine therapy (ET) combined with targeted therapies has shown efficacy in ET-sensitive mILC, data on chemotherapy in ET-refractory mILC remain limited. We investigated the efficacy of single-agent capecitabine (CAP) versus taxanes (TAX) in ET-refractory HR+ HER2-negative patients with mILC.
Results
CAP-treated patients had significantly better median progression-free survival (PFS) than TAX-treated patients (8.8 vs 5.0 months, HR 0.63, P < .001). Overall survival (OS) did not differ significantly between the groups (42.7 vs 36.6 months for CAP vs TAX, respectively, HR 0.84, P = .241). Multivariate analyses for PFS and OS revealed better outcomes in subjects with fewer metastatic sites and those exposed to more lines of ET. Additionally, Black patients showed worse OS outcomes compared to White patients (HR 2.46; P = .001).
Conclusion
In ET-refractory HR+ HER2-negative mILC, single-agent CAP demonstrated superior PFS compared to TAX. Our findings highlight the potential benefit of CAP in this patient subset, warranting further investigation through prospective trials.
Acknowledgment
The MD Anderson prospectively collected breast cancer database and its current director Dr. Carlos Barcenas. The project was presented as a poster at the European Society of Medical Oncology (ESMO) Breast Cancer Congress in Berlin, Germany, 11-13 May 2023.
Funding
The study analyses in this work were supported in part by the NIH/NCI Cancer Center Support Grant (Award number P30 CA016672) and the Cancer Prevention and Research Institute of Texas (CPRIT) grant that contributed to the recent updates of our database (CPRIT MIRA RP170067, RP170079, and RP180712).
Conflict of Interest
Jason A. Mouabbi reports consulting fees from GE Healthcare, Genentech, AstraZeneca, Gilead, Novartis, Fresenius Kabi, BostonGene, and Cardinal Health. Debasish Tripathy reports research support from Novartis and Pfizer along with consulting fees from Novartis, Pfizer, and AstraZeneca. Rachel Layman reports research support from Novartis, Pfizer, Eli Lilly, Accutar Biotechnology, Puma, Celcuity, Zentalis, and Arvinas along with consulting fees from Eli Lilly, Novartis, Celcuity, Gilead, Biotheryx. Wei Qaio, Yu Shen, and Akshara Singareeka Raghavendra report no conflict of interest.
Author Contributions
Conception/Design: J.A.M., D.T., and R.M.L. Provision of study material or patients: A.S.R., W.Q, and Y.S. Collection and/or assembly of data: A.S.R. Data analysis and interpretation: J.A.M, W.Q., and Y.S. Manuscript writing: J.A.M. Final approval of manuscript: J.A.M., W.Q., Y.S., A.S.R., D.T., and R.M.L.
Data Availability
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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© The Author(s) 2023. Published by Oxford University Press.
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