Comparative Efficacy of First-Line Chemotherapy and Endocrine Therapy in Hormone Receptor-Positive HER2-Negative Metastatic Breast Cancer: A Retrospective Analysis | ||
| Egyptian Journal of Cancer and Biomedical Research | ||
| Volume 9, Issue 3, September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/jcbr.2025.394007.1406 | ||
| Authors | ||
| Emad Shash* 1; Sally Gaber2; Hossam Eldin A. Elashtoky2; Nasr Mohamed Ali Allahloubi3 | ||
| 1Medical Oncology Department, National Cancer Institute, Cairo University | ||
| 2Medical Oncology, Tanta Cancer Center, Gharbia, Egypt | ||
| 3Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt | ||
| Abstract | ||
| Background International guidelines endorse endocrine therapy (ET) as first-line treatment for hormone-receptor–positive, HER2-negative metastatic breast cancer (HR+/HER2– MBC) except in the setting of visceral crisis. Aim To compare real-world survival outcomes with first-line ET versus chemotherapy (CT) in an Egyptian cohort treated before CDK4/6 inhibitors became available. Methods We retrospectively reviewed 200 consecutive HR+/HER2– MBC patients managed at Tanta Cancer Center between January 2013 and December 2018. Clinicopathologic variables and systemic therapies were abstracted from medical records. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared with log-rank tests; independent prognostic factors were explored with multivariable Cox regression. Results Of the 200 patients, 149 (74.5 %) received CT and 51 (25.5 %) ET as initial systemic therapy. Median OS for the entire cohort was 56 months. ET conferred a significant OS advantage over CT (median not reached vs 51.5 months; p = 0.021). Among patients presenting with visceral metastases, OS remained superior with ET (not reached vs 46 months; p = 0.003). PFS did not differ between groups (15.8 months ET vs 15.8 months CT; p = 0.816). Conclusion In this pre-CDK4/6-inhibitor era, first-line ET was associated with longer OS than CT in Egyptian patients with HR+/HER2– MBC, even when visceral disease was present. These findings reinforce guideline-based use of endocrine-based regimens and provide a benchmark for evaluating the added value of newer targeted combinations. | ||
| Keywords | ||
| metastatic breast cancer; chemotherapy; endocrine therapy; Real-world evidence; Survival outcomes | ||
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