The role of histological subtype in hormone receptor positive metastatic breast cancer: similar survival but different therapeutic approaches
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Dorien Lobbezoo1,2, Wilfred Truin1,3, Adri Voogd1, Rudi Roumen1,3, Gerard Vreugdenhil1,2, Marcus Wouter Dercksen2, Franchette van den Berkmortel4, Tineke Smilde5, Agnes van de Wouw6, Roel van Kampen1,7, Johanna van Riel8, Natascha Peters9, Petronella Peer10, Vivianne C.G. Tjan-Heijnen1
1GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
2Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
3Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
4Department of Internal Medicine, Atrium-Orbis, Heerlen, The Netherlands
5Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
6Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
7Department of Internal Medicine, Atrium-Orbis, Sittard, The Netherlands
8Department of Internal Medicine, St Elisabeth Hospital, Tilburg, The Netherlands
9Department of Internal Medicine, St Jans Hospital, Weert, The Netherlands
10Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
Vivianne C.G. Tjan-Heijnen, email: [email protected]
Keywords: metastatic breast cancer, histology, invasive lobular carcinoma, invasive ductal carcinoma, treatment
Received: December 06, 2015 Accepted: March 28, 2016 Published: April 19, 2016
Introduction: This study describes the differences between the two largest histological breast cancer subtypes (invasive ductal carcinoma (IDC) and invasive (mixed) lobular carcinoma (ILC) with respect to patient and tumor characteristics, treatment-choices and outcome in metastatic breast cancer.
Results: Patients with ILC were older at diagnosis of primary breast cancer and had more often initial bone metastasis (46.5% versus 34.8%, P = 0.01) and less often multiple metastatic sites compared to IDC (23.7% versus 30.9%, P = 0.11). Six months after diagnosis of metastatic breast cancer, 28.1% of patients with ILC and 39.8% of patients with IDC had received chemotherapy with a longer median time to first chemotherapy for those with ILC (P = 0.001). After six months 84.8% of patients with ILC had received endocrine therapy versus 72.5% of patients with IDC (P = 0.0001). Median overall survival was 29 months for ILC and 25 months for IDC (P = 0.53).
Materials and Methods: We included 437 patients with hormone receptor-positive IDC and 131 patients with hormone receptor-positive ILC, all diagnosed with metastatic breast cancer between 2007–2009, irrespective of date of the primary diagnosis. Patient and tumor characteristics and data on treatment and outcome were collected. Survival curves were obtained using the Kaplan-Meier method.
Conclusions: Treatment strategies of hormone receptor-positive metastatic breast cancer were remarkably different for patients with ILC and IDC. Further research is required to understand tumor behavior and treatment-choices in real-life.
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