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Antoine A, Pérol D, Robain M, Delaloge S, Lasset C, Drouet Y. Target trial emulation to assess real-world efficacy in the Epidemiological Strategy and Medical Economics metastatic breast cancer cohort. J Natl Cancer Inst 2023; 115:971-980. [PMID: 37220893 PMCID: PMC10407701 DOI: 10.1093/jnci/djad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Real-world data studies usually consider biases related to measured confounders. We emulate a target trial implementing study design principles of randomized trials to observational studies; controlling biases related to selection, especially immortal time; and measured confounders. METHODS This comprehensive analysis emulating a randomized clinical trial compared overall survival in patients with HER2-negative metastatic breast cancer (MBC), receiving as first-line treatment, either paclitaxel alone or combined to bevacizumab. We used data from 5538 patients extracted from the Epidemiological Strategy and Medical Economics-MBC cohort to emulate a target trial using advanced statistical adjustment techniques including stabilized inverse-probability weighting and G-computation, dealing with missing data with multiple imputation, and performing a quantitative bias analysis for residual bias due to unmeasured confounders. RESULTS Emulation led to 3211 eligible patients, and overall survival estimates achieved with advanced statistical methods favored the combination therapy. Real-world effect sizes were close to that assessed in the existing E2100 randomized clinical trial (hazard ratio = 0.88, P = .16), but the increased sample size allowed to achieve a higher level of precision in real-world estimates (ie, reduced confidence intervals). Quantitative bias analysis confirmed the robustness of the results with respect to potential unmeasured confounding. CONCLUSION Target trial emulation with advanced statistical adjustment techniques is a promising approach to investigate long-term impact of innovative therapies in the French Epidemiological Strategy and Medical Economics-MBC cohort while minimizing biases and provides opportunities for comparative efficacy through the synthetic control arms provided. DATABASE REGISTRATION clinicaltrials.gov Identifier NCT03275311.
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Affiliation(s)
- Alison Antoine
- Clinical Research and Biostatistics Department, Centre Léon Bérard, Lyon, France
- UMR CNRS 5558 LBBE, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - David Pérol
- Clinical Research and Biostatistics Department, Centre Léon Bérard, Lyon, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Christine Lasset
- UMR CNRS 5558 LBBE, Claude Bernard Lyon 1 University, Villeurbanne, France
- Prevention & Public Health Department, Centre Léon Bérard, Lyon, France
| | - Youenn Drouet
- UMR CNRS 5558 LBBE, Claude Bernard Lyon 1 University, Villeurbanne, France
- Prevention & Public Health Department, Centre Léon Bérard, Lyon, France
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Grinda T, Antoine A, Jacot W, Cottu PH, de la Motte Rouge T, Frenel JS, Mailliez A, Dalenc F, Goncalves A, Clatot F, Mouret Reynier MA, Levy C, Ferrero JM, Desmoulins I, Uwer L, Petit T, Jouannaud C, Arnedos M, Chevrot M, Courtinard C, Tredan O, Brain E, Pérol D, Pistilli B, Delaloge S. Real-world clinical and survival outcomes of patients with early relapsed triple-negative breast cancer from the ESME national cohort. Eur J Cancer 2023; 189:112935. [PMID: 37385070 DOI: 10.1016/j.ejca.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Early metastatic relapse of triple-negative breast cancer (mTNBC) after anthracyclins and/or taxanes based (A/T) primary treatment represents a highly aggressive cancer situation requiring urgent characterisation and handling. Epidemio-Strategy-Medico-Economical-Metastatic Breast Cancer (ESME-MBC) database, a multicenter, national, observational cohort (NCT03275311) provides recent data on this entity. METHODS All ESME patients diagnosed between 2008 and 2020 with mTNBC occurring as a relapse after a systemic neoadjuvant/adjuvant taxane and/or anthracycline-based chemotherapy were included. Early relapses were defined by a metastatic diagnosis up to 12 months of the end of neo/adjuvant A/T chemotherapy. We assessed overall survival (OS) and progression-free-survival under first-line treatment (PFS1) by early versus late relapse (≥12 months). RESULTS Patients with early relapse (N = 881, 46%) were younger and had a larger tumour burden at primary diagnosis than those with late relapses (N = 1045). Early relapse rates appeared stable over time. Median OS was 10.1 months (95% CI 9.3-10.9) in patients with early relapse versus 17.1 months (95% CI 15.7-18.2) in those with late relapse (adjusted hazard-ratio (aHR): 1.92 (95% CI 1.73-2.13); p < 0.001). The median PFS1 was respectively 3.1 months (95% CI 2.9-3.4) and 5.3 months (95% CI 5.1-5.8); (aHR: 1.66; [95% CI 1.50-1.83]; p < 0.001). Among early relapsed patients, a higher number of metastatic sites, visceral disease but not treatment types, were independently associated with a poorer OS. CONCLUSION These real-world data provide strong evidence on the dismal prognosis, higher treatment resistance and major unmet medical need associated with early relapsed mTNBC. Database registration: clinicaltrials.gov Identifier NCT032753.
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Affiliation(s)
- Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Sorbonne University, Medicine, 21 rue de l'École de médecine, 75006 Paris, France.
| | - Alison Antoine
- Department of Biostatistics, DRCI, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM U1194, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Paul-Henri Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Thibault de la Motte Rouge
- Department of Medical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Pays de Loire, 15 rue André Boquel, 49055 Angers, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Marie-Ange Mouret Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont Ferrand, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 06000 Nice, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, 21079 Dijon, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Monica Arnedos
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Michaël Chevrot
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, 33000 Bordeaux, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - David Pérol
- Department of Biostatistics, DRCI, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
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Cytryn S, S. joshi, Ku G, Maron S, Desai A, Yang J, Rao D, Goldberg Z, Sugarman R, Antoine A, Socolow F, Chou J, Capanu M, Gerdes H, Simmons M, Paroder V, Tang L, Shia J, Ilson D, Janjigian Y. 1227P Regorafenib (REGO) with nivolumab (NIVO) and FOLFOX in HER2 negative esophagogastric cancer (EGC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Courtinard C, Gourgou S, Jacot W, M. Carton, Filleron T, Couch D, Asselain B, Le Deley MC, Vacher L, Antoine A, Parent D, R. Schiappa, Breton M, Michiels S, Brain E, Guérin O, Loeb A, Perrocheau G, Simon G, Bellera C. 250P Association between progression free survival and overall survival in women receiving first-line treatment for metastatic breast cancer: Evidence from the ESME real-world database. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Antoine A, Pérol D, Gilberg M, Lasset C, Choquet R, Robain M, Yahia BBH, Drouet Y. Utilisation des données de vie réelle pour estimer l'effet traitement en cancérologie: émulation du protocole de l'essai randomisé E2100 à partir de la base nationale ESME. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Deluche E, Antoine A, Bachelot T, Robain M, Perol D, Delaloge S. A response letter to comments on "Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008-2016". Eur J Cancer 2020; 140:165-166. [PMID: 33020000 DOI: 10.1016/j.ejca.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, CHU de Limoges, France
| | - Alison Antoine
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - David Perol
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
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Deluche E, Antoine A, Bachelot T, Lardy-cleaud A, Dieras V, Brain E, Jacot W, Goncalves A, Dalenc F, Patsouris A, Mathoulin-Pelissier S, Courtinard C, Perol D, Robain M, Delaloge S. Contemporary picture of metastatic breast cancer: Characteristics and outcomes of 22,000 women from the ESME cohort 2008–2016. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delaloge S, Antoine A, Debled M, Jacot W, Cottu P, Dieras V, Dalenc F, Gonçalves A, Patsouris A, Reynier MM, Mailliez A, Clatot F, Levy C, Ferrero JM, Desmoulins I, Uwer L, Robain M, Bachelot T, Brain E, Perol D. 279MO Divergent evolution of overall survival across metastatic breast cancer (MBC) subtypes in the nationwide ESME real life cohort 2008-2016. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Curto R, Antoine A, Cuquel A, Jarré C, Larréché S, Bigaillon C, Conan P, Andriamanantena D, Ficko C. Co-administrations intraveineuses d’antibiotiques : ne pas se précipiter ! Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deluche E, Antoine A, Bachelot T, Lardy-Cleaud A, Dieras V, Brain E, Debled M, Jacot W, Mouret-Reynier MA, Goncalves A, Dalenc F, Patsouris A, Ferrero JM, Levy C, Lorgis V, Vanlemmens L, Lefeuvre-Plesse C, Mathoulin-Pelissier S, Petit T, Uwer L, Jouannaud C, Leheurteur M, Lacroix-Triki M, Courtinard C, Perol D, Robain M, Delaloge S. Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008-2016. Eur J Cancer 2020; 129:60-70. [PMID: 32135312 DOI: 10.1016/j.ejca.2020.01.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/26/2022]
Abstract
AIM Real-world data inform the outcome comparisons and help the development of new therapeutic strategies. To this end, we aimed to describe the full characteristics and outcomes in the Epidemiological Strategy and Medical Economics (ESME) cohort, a large national contemporary observational database of patients with metastatic breast cancer (MBC). METHODS Women aged ≥18 years with newly diagnosed MBC and who initiated MBC treatment between January 2008 and December 2016 in one of the 18 French Comprehensive Cancer Centers (N = 22,109) were included. We assessed the full patients' characteristics, first-line treatments, overall survival (OS) and first-line progression-free survival, as well as updated prognostic factors in the whole cohort and among the 3 major subtypes: hormone receptor positive and HER2-negative (HR+/HER2-, n = 13,656), HER2-positive (HER2+, n = 4017) and triple-negative (n = 2963) tumours. RESULTS The median OS of the whole cohort was 39.5 months (95% confidence interval [CI], 38.7-40.3). Five-year OS was 33.8%. OS differed significantly between the 3 subtypes (p < 0.0001) with a median OS of 43.3 (95% CI, 42.5-44.5) in HR+/HER2-; 50.1 (95% CI, 47.6-53.1) in HER2+; and 14.8 months (95% CI, 14.1-15.5) in triple-negative subgroups, respectively. Beyond performance status, the following variables had a constant significant negative prognostic impact on OS in the whole cohort and among subtypes: older age at diagnosis of metastases (except for the triple-negative subtype), metastasis-free interval between 6 and 24 months, presence of visceral metastases and number of metastatic sites ≥ 3. CONCLUSIONS The ESME program represents a unique large-scale real-life cohort on MBC. This study highlights important situations of high medical need within MBC patients. DATABASE REGISTRATION: clinicaltrials.gov Identifier NCT032753.
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Affiliation(s)
- Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France; Department of Medical Oncology, CHU de Limoges, France
| | - Alison Antoine
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Audrey Lardy-Cleaud
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Veronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, Paris & Saint-Cloud, 75005, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, Bordeaux, 33000, France
| | - William Jacot
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, Montpellier, 34298, France
| | - Marie Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, Clermont Ferrand, 63011, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, Marseille, 13009, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, Toulouse, 31059, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, Angers, 49055, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, Nice, 06189, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, Caen, 14000, France
| | - Veronique Lorgis
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, Dijon, 21079, France
| | - Laurence Vanlemmens
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, Lille, 59000, France
| | - Claudia Lefeuvre-Plesse
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, Strasbourg, 67000, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, Vandœuvre-lès-Nancy, 54519, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, Reims, 51100, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, Rouen, 76000, France
| | - Magali Lacroix-Triki
- Department of BioPathology, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - David Perol
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France.
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Antoine A. [The seigniorial class, the land, and the peasants, 17th-18th centuries]. Rev Hist Mod Contemp 1999; 46:15-33. [PMID: 22224222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Antoine A. [Agricultural practices in western of France: an unrecognized rationality?]. Hist Econ Soc 1999; 18:107-132. [PMID: 21213627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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