Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Shirley Mertz; Christine Benjamin; Charis Girvalaki; Antonella Cardone; Paulina Gono; Suepattra G May; Erin Comerford; Kyi-Sin Than; Kelly Birch; Meaghan Roach; Sky Myers; Medha Sasane; Liat Lavi; Anna Cameron; Fatima Cardoso

doi:10.1016/j.breast.2022.07.006

Progression-free survival and quality of life in metastatic breast cancer: The patient perspective

Breast. 2022 Oct:65:84-90. doi: 10.1016/j.breast.2022.07.006. Epub 2022 Jul 9.

Authors

Shirley Mertz¹, Christine Benjamin², Charis Girvalaki³, Antonella Cardone³, Paulina Gono³, Suepattra G May⁴, Erin Comerford⁵, Kyi-Sin Than⁶, Kelly Birch⁶, Meaghan Roach⁶, Sky Myers⁶, Medha Sasane⁵, Liat Lavi⁵, Anna Cameron⁵, Fatima Cardoso⁷

Affiliations

¹ Metastatic Breast Cancer Network, 165 West 46th St, Suite 712, New York, NY, 10036, USA.
² SHARE Cancer Support, 165 West 46th St, Suite 712, New York, NY, 10036, USA.
³ European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium.
⁴ PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA. Electronic address: suepattra.may-slater@precisionvh.com.
⁵ Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA.
⁶ PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA.
⁷ Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal.

Abstract

Introduction: Treatment advances for metastatic breast cancer (mBC) have improved overall survival (OS) in some mBC subtypes; however, there remains no cure for mBC. Considering the use of progression-free survival (PFS) and other surrogate endpoints in clinical trials, we must understand patient perspectives on measures used to assess treatment efficacy.

Objective: To explore global patient perceptions of the concept of PFS and its potential relation to quality of life (QoL).

Materials and methods: Virtual roundtables in Europe and the United States and interviews in Japan with breast cancer patients, patient advocates, and thought leaders. Discussions were recorded, transcribed, and analyzed thematically.

Results: Lengthened OS combined with no worsening or improvement in QoL remain the most important endpoints for mBC patients. Time when the disease is not progressing is meaningful to patients when coupled with improvements in QoL and no added treatment toxicity. Clinical terminology such as "PFS" is not well understood, and participants underscored the need for patient-friendly terminology to better illustrate the concept. Facets of care that patients with mBC value and that may be related to PFS include relief from cancer-related symptoms and treatment-related toxicities as well as the ability to pursue personal goals. Improved communication between patients and providers on managing treatment-related toxicities and addressing psychosocial challenges to maintain desired QoL is needed.

Conclusion: While OS and QoL are considered the most relevant endpoints, patients also value periods of time without disease progression. Incorporation of these considerations into the design and conduct of future clinical trials in mBC, as well as HTA and reimbursement decision-making, is needed to better capture the potential value of a therapeutic innovation.

Keywords: Breast cancer; Metastatic; Patient-centered; Progression-free survival; Qualitative research; Quality of life.

MeSH terms

Breast Neoplasms* / drug therapy
Disease Progression
Female
Humans
Progression-Free Survival
Quality of Life*
Treatment Outcome