Long-term survival in HER2-positive metastatic breast cancer treated with first-line trastuzumab: results from the french real-life curie database.

BACKGROUND: Outcome of HER2-positive metastatic breast cancer (MBC) patients has improved since the use of trastuzumab. However, most HER2-positive MBC patients will progress within 1 year of trastuzumab-based therapy. Only limited data are available concerning long-term responders. METHODS: The primary objective of this study was to compare overall survival (OS) of HER2+ MBC patients with long-term response to first-line trastuzumab with overall survival of those with non-long-term response, based on two institutional databases: the French Epidemiological Strategy and Medical Economics program and the Breast Database. Long-term responders (LTR) were defined as patients with non-progressive disease for ≥ 2 years on first-line trastuzumab. Secondary objectives included progression-free survival (PFS), and predictive factors for LTR status. RESULTS: From 2004 to 2014, 422 HER2-positive MBC patients received first-line trastuzumab. With a median follow-up of 48 months, median OS and PFS were 63 months (CI95%, 50-71), and 18 months (CI95%, 15-21) respectively. In 111 patients (26.3%) classified as LTR, median OS was 110 months (CI95%, 95-not reached) versus 56 months in non-LTR patients (CI95%, 47-68). In multivariate logistic regressions, the following factors were independently associated with LTR status: number of metastatic sites (≤ 2 versus > 2, p = 0.01); endocrine therapy for metastatic disease (p = 0.001) and taxane-based first-line chemotherapy (p = 0.003). CONCLUSION: Several features are associated with long-term response to trastuzumab: few metastatic sites, taxane-based chemotherapy and maintenance endocrine therapy in HR+ patients. Further studies are needed to identify patients in whom trastuzumab can be stopped after several years of sustained response.

Silent dropouts in health surveys: are nonrespondent absent teenagers different from those who participate in school-based health surveys?

OBJECTIVE: To compare the health problems, needs and behavior of pupils absent from school with participants in the Swiss Multicenter Adolescent Survey on Health. METHODS: The present pupils' group (N = 3324; adolescents between 15 and 20 years old, randomly selected from high schools and professional centers of French-speaking Switzerland) answered a self-administered anonymous questionnaire. The absent pupils group (N = 96) was questioned on the phone by means of a shorter but similar version of the questionnaire. RESULTS: The proportion of respondents reporting skin problems, weight concerns, sleep difficulties, headaches, stomach aches, as well as vision or dental problems was higher in the present pupils sample (p < 0.01). The percentages of teenagers reporting the need for help were higher in the present pupils sample than in the absent group: nutrition (21.8 vs. 9.4, p < 0.01) stress (44.2 vs. 31.3, p < 0.05), depression (28.4 vs. 18.9, p < 0.05), sleep problems (21.3 vs. 12.1, p < 0.05), sports (9.2 vs. 4.2, p < 0.05), and love life (31.5 vs. 14.5, p < 0.01). The rates of hospitalizations and injuries were lower among absent pupils (28.2 vs. 40.1, p < 0.01). A higher proportion of absent students were sexually active (p < 0.05). They had a tendency to use tobacco, alcohol, and cannabis more frequently than did present pupils (p < 0.05). CONCLUSION: Within the Swiss context, nonparticipation owing to school absenteeism is probably related less to physical or chronic health problems that to lifestyles which predispose these students to truancy.

PIP: 3324 in-school students aged 15-20 years randomly selected from high schools and professional centers in francophone Switzerland answered a self-administered questionnaire about their health problems, needs, and behavior. Their responses were compared with those of 96 absent students sampled via telephone on a shorter, but similar questionnaire. Relative to the absent students, a significantly higher percentage of in-school students reported skin problems, weight concerns, sleep problems, headaches, stomach aches, and vision or dental problems. The percentages of students reporting a need for help were also higher among present students than among those who were absent: nutrition, 21.8 vs. 9.4; stress, 44.2 vs. 31.3; depression, 28.4 vs. 18.9; sleep problems, 21.3 vs. 12.1; sports, 9.2 vs. 4.2; and love life, 31.5 vs. 14.5. The rates of hospitalization and injuries were lower among absent students, 28.2 vs. 40.1. A higher proportion of absent students were sexually active and they also had a tendency to use tobacco, alcohol, and cannabis more often than did present students. Absent students also more frequently partook of leisure and group activities. Study findings suggest that within the Swiss context, school absenteeism is probably related less to physical or chronic health problems than to hedonistic lifestyles which predispose some students skip part of the school hours.