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Clinico-radiological monitoring strategies in patients with metastatic breast cancer: a real-world study

    Marta Bonotto

    *Author for correspondence: Tel.: +39 0 432 552751; Fax: +39 0 432 55 2751;

    E-mail Address: marta.bonotto@asufc.sanita.fvg.it

    Department of Oncology, University Academic Hospital, Udine, Italy

    Authors contributed equally

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    ,
    Debora Basile

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    Authors contributed equally

    Search for more papers by this author

    ,
    Lorenzo Gerratana

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Michele Bartoletti

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Camilla Lisanti

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Giacomo Pelizzari

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Maria Grazia Vitale

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Valentina Fanotto

    Department of Oncology, University Academic Hospital, Udine, Italy

    Department of Medicine, University of Udine, Udine, Italy

    ,
    Elena Poletto

    Department of Oncology, University Academic Hospital, Udine, Italy

    ,
    Alessandro Marco Minisini

    Department of Oncology, University Academic Hospital, Udine, Italy

    ,
    Stefania Russo

    Department of Oncology, University Academic Hospital, Udine, Italy

    ,
    Claudia Andreetta

    Department of Oncology, University Academic Hospital, Udine, Italy

    ,
    Mauro Mansutti

    Department of Oncology, University Academic Hospital, Udine, Italy

    ,
    Gianpiero Fasola

    Department of Oncology, University Academic Hospital, Udine, Italy

    &
    Fabio Puglisi

    Department of Medicine, University of Udine, Udine, Italy

    Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, 33081 Aviano, Italy

    Published Online:https://doi.org/10.2217/fon-2020-0020

    Aim: A monitoring strategy for metastatic breast cancer patients (M-MBC) has been little studied. Materials & methods: This retrospective study analyzed a consecutive cohort of 382 MBC patients to analyze different M-MBC strategies to identify factors influencing intensive M-MBC. Results: Elevated baseline serum tumor markers (STM) was the strongest factor associated with increased use of STM tests. Having more frequent oncology office visits was associated with more intensive chemotherapy/magnetic resonance imaging (MRI) using. Increased use of imaging tests was associated with participation to clinical trial. Single and elderly patients were less likely to have frequent testing. Having clinically measurable disease was less likely to have more intensive M-MBC. Conclusion: STM testing and scans were frequently ordered in M-MBC. In the present study, strategies are little influenced by clinico-pathological characteristics.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J. Clin. 68(1), 7–30 (2018).
    • 2. Chang J, Clark GM, Allred DC, Mohsin S, Chamness G, Elledge RM. Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor. Cancer 97(3), 545–553 (2003).
    • 3. Bonotto M, Gerratana L, Poletto E et al. Measures of outcome in metastatic breast cancer: insights from a real-world scenario. Oncologist 19(6), 608–615 (2014).
    • 4. Bonotto M, Gerratana L, Di Maio M et al. Chemotherapy versus endocrine therapy as first-line treatment in patients with luminal-like HER2-negative metastatic breast cancer: a propensity score analysis. Breast 31, 114–120 (2017).
    • 5. Chia SK, Speers CH, D'yachkova Y et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer 110(5), 973–979 (2007).
    • 6. Panageas KS, Ben-Porat L, Dickler MN, Chapman PB, Schrag D. When you look matters: the effect of assessment schedule on progression-free survival. J. Natl Cancer Inst. 99(6), 428–432 (2007). •• Panageas shows that the physician’s M-metastatic breast cancer (MBC) strategy could impact on the formal duration of PFS and therefore bias the consequent applicability of clinical trial-derived data.
    • 7. Eisenhauer EA, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer 45(2), 228–247 (2009).
    • 8. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 47(1), 207–214 (1981).
    • 9. Bonotto M, Gerratana L, Iacono D et al. Treatment of metastatic breast cancer in a real-world scenario: is progression-free survival with first line predictive of benefit from second and later lines? Oncologist 20(7), 719–724 (2015).
    • 10. Accordino MK, Wright JD, Vasan S et al. Use and costs of disease monitoring in women with metastatic breast cancer. J. Clin. Oncol. 34(24), 2820–2826 (2016).
    • 11. Bauml JM, Troxel A, Epperson CN et al. Scan-associated distress in lung cancer: quantifying the impact of “scanxiety.”. Lung Cancer 100, 110–113 (2016).
    • 12. Bonotto M, Basile D, Gerratana L et al. Controversies in monitoring metastatic breast cancer during systemic treatment. Results of a GIM (Gruppo Italiano Mammella) survey. Breast 40, 45–52 (2018).
    • 13. Gnant M, Harbeck N, Thomssen C. St. Gallen/Vienna 2017: a brief summary of the consensus discussion about escalation and de-escalation of primary breast cancer treatment. Breast Care 12(2), 101–106 (2017).
    • 14. Cardoso F, Senkus E, Costa A et al. 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Ann. Oncol. 29(8), 1634–1657 (2018). •• ESMO International Consensus Guidelines for Advanced BC recommends the strategy for imaging evaluation for endocrine therapy and for CHT, with a Level of Evidence and Grades of Recommendations and a consensus of 81%.
    • 15. Gradishar WJ, Anderson BO, Abraham J. NCCN Guidelines Index Table of Contents Discussion. Breast Cancer 3(18), 212 (2018).
    • 16. Di Meglio A, Lin NU, Freedman RA, Barry WT, Winer EP, Vaz-Luis I. Patterns of utilization of imaging studies and serum tumor markers among patients with de novo metastatic breast cancer. J. Natl Compr. Canc. Netw. 15(3), 316–324 (2017). • Di Meglio et al. describe the patterns of imaging and serum tumor marker use outside of clinical trials.
    • 17. Accordino MK, Wright JD, Vasan S et al. Serum tumor marker use in patients with advanced solid tumors. J. Oncol. Pract. 12(1), 65–66 (2016). •• Accordino et al. define extreme users and not of disease-monitoring tests on the basis of monitoring patterns in clinical trials and of a previously published study about overuse of serum tumor marker testing.
    • 18. Dinan MA, Curtis LH, Hammill BG et al. Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999-2006. JAMA 303(16), 1625–1631 (2010). • Dinan et al. show that disease monitoring impacts not only on clinical practice but also on health care costs, quality of life and on the interpretation and transferability of clinical studies' data.
    • 19. Ghezzi P, Magnanini S, Rinaldini M et al. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients: a multicenter randomized controlled trial. JAMA 271(20), 1587–1592 (1994).
    • 20. Parker PA, Kudelka A, Basen-Engquist K, Kavanagh J, de Moor J, Cohen L. The associations between knowledge, CA125 preoccupation, and distress in women with epithelial ovarian cancer. Gynecol. Oncol. 100(3), 495–500 (2006).
    • 21. Seah DSE, Luis IV, Macrae E et al. Use and duration of chemotherapy in patients with metastatic breast cancer according to tumor subtype and line of therapy. J. Natl Compr. Canc. Netw. 12(1), 71–80 (2014).
    • 22. Finn RS, Martin M, Rugo HS et al. Palbociclib and letrozole in advanced breast cancer. N. Engl. J. Med. 375(20), 1925–1936 (2016).
    • 23. Smerage JB, Barlow WE, Hortobagyi GN et al. Circulating tumor cells and response to chemotherapy in metastatic breast cancer: SWOG S0500. J. Clin. Oncol. 32(31), 3483–3489 (2014). •• Shows that an alternative M-MBC method may be represented by serial enumeration of circulating tumor cells during MBC treatment.