Treatment and outcome for HER2 positive metastatic breast cancer patients: A Danish retrospective cohort.
Author
Hellerup, Sebastian Holm
Term
5. Term (Master thesis)
Education
Publication year
2025
Submitted on
2025-12-29
Pages
22
Abstract
HER2-positive metastatic breast cancer (HER2+ MBC) often spreads to the central nervous system (CNS; for example, the brain and spinal cord) and is linked to a poor outlook. In recent years, newer targeted treatments have improved survival, but Danish real-world evidence remains limited. We conducted a retrospective cohort study of 100 patients with de novo or recurrent HER2+ MBC treated with first-line dual anti-HER2 therapy at Aalborg University Hospital from 2014 to 2024. We estimated progression-free survival (PFS; the time until the cancer worsens) and overall survival (OS; how long patients live) using Kaplan–Meier methods, and assessed prognostic factors with Cox regression. Factors included performance status (PS; general functional well-being), tumor burden (the amount of cancer in the body), estrogen receptor status, age, and CNS metastases. Median PFS was 15.7, 7.7, and 4.5 months in first-, second-, and third-line therapy, respectively. Median OS for the full cohort was 49.3 months. High tumor burden, having or developing CNS metastases, and worse performance status (PS >0) were associated with shorter PFS and OS. In multivariable analysis, CNS metastases (HR 2.31), high tumor burden (HR 1.88), and PS 2 (HR 4.46) remained independent predictors of worse survival. Tumor burden predicted time to CNS metastases, whereas estrogen receptor status did not. These Danish real-world outcomes align with international data and support the effectiveness of current treatment guidelines, while highlighting that CNS involvement, tumor burden, and functional status have a major impact on survival and warrant continued refinement of care for these groups.
HER2-positiv metastatisk brystkræft (HER2+ MBC) har ofte tendens til at sprede sig til centralnervesystemet (CNS; fx hjerne og rygmarv) og er forbundet med en dårlig prognose. Nye, målrettede behandlinger har dog forbedret overlevelsen. Dansk viden fra daglig klinik er begrænset. Vi gennemførte derfor et retrospektivt kohortestudie af 100 patienter diagnosticeret med de novo eller recidiverende HER2+ MBC og behandlet med første-linjens dobbelt anti-HER2-behandling på Aalborg Universitetshospital 2014–2024. Vi opgjorde progressionsfri overlevelse (PFS; tiden til sygdommen forværres) og samlet overlevelse (OS; hvor længe patienterne lever) med Kaplan–Meier-metoder samt undersøgte prognostiske faktorer med Cox-regressionsmodeller. Faktorerne omfattede funktionsniveau (performance status, PS), tumorbyrde (mængden af kræft i kroppen), østrogenreceptorstatus, alder og CNS-metastaser. Den mediane PFS var 15,7, 7,7 og 4,5 måneder i henholdsvis første-, anden- og tredjelinjebehandling. Den mediane OS for hele kohorten var 49,3 måneder. Høj tumorbyrde, tilstedeværelse eller udvikling af CNS-metastaser samt dårligere funktionsniveau (PS >0) var forbundet med kortere PFS og OS. I multivariat analyse var CNS-metastaser (HR 2,31), høj tumorbyrde (HR 1,88) og PS 2 (HR 4,46) uafhængige markører for dårligere overlevelse. Tumorbyrde forudsagde tiden til udvikling af CNS-metastaser, mens østrogenreceptorstatus ikke gjorde. Resultaterne ligner internationale real-world data og understøtter effekten af gældende behandlingsretningslinjer. Samtidig viser de, at CNS-spredning, tumorbyrde og funktionsniveau har stor betydning for overlevelse, hvilket peger på behovet for at finjustere behandlingen for disse patientgrupper.
[This apstract has been rewritten with the help of AI based on the project's original abstract]
Keywords
kræft ; brystkræft ; HER2 ; metastase