Recent treatment and survival trends in older versus younger women with HR-positive HER2-negative metastatic breast cancer in the real-life multicenter French ESME cohort
Menée en France à partir des données de la base "ESME" portant sur 17 830 patientes atteintes d'un cancer du sein HR+ HER2- de stade métastatique (âge médian : 62 ans), cette étude multicentrique analyse les traitements reçus et la survie associée en fonction de la catégorie d'âge (âge inférieur ou supérieur à 70 ans)
Aim: To describe first-line treatments, overall (OS) and real-world progression-free (rwPFS) survival in women with hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) following introduction of CDK4/6 inhibitors (CDK4/6i), according to age (<70; 70+) and diagnostic period (before/after CDK4/6i).
Methods: We extracted data from the ESME database (NCT03275311) which includes consecutive patients starting first-line mBC in one of the 18 French Comprehensive cancer centres.
Results: We identified 17,830 eligible women (median age: 62 years). Women aged ≥70 years were less likely to present with aggressive disease characteristics. Use of endocrine therapy combined with CDK4/6i increased substantially over time in both age groups, from 0.9% to 48.9% in 70+ women, and from 0.8% to 50.1% in women <70 (p<0.001 for both). In contrast, first-line chemotherapy (alone or in combination) declined from 52.7% to 30.0% (p<0.001), with consistently lower use among women 70+ compared to those <70: 32.2% vs. 61.1% prior to 2016, and 16.4% vs. 36.5% after 2017 (p<0.001 for both). Among 70+ women, OS improved over time (34.0 to 37.3 months, p=0.03) but remained shorter than in younger women. rwPFS improved in both age groups: from 12.6 to 14.8 months in 70+ women, and from 12.3 to 14.4 months in women <70 (p<0.001 for both).
Conclusion: ET+CDK4/6i use rose up to ~50% after 2017, reaching ~70% in recent years among women with good PS, but remained ~50% in older patients with poor PS. Broader adoption is needed, with less chemotherapy use. Survival outcomes have improved but, causality cannot be confirmed due to the observational design.
European Journal of Cancer , résumé, 2025