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| Title | Ten-Year Subtype Survival and Systemic-Therapy Pathways Analysis after Breast-Cancer Recurrence in the LACRN MPBC Multicountry Cohort Study |
| Authors | Javier Retamales, Ingiborg Araya, Eliana Abdelhay, Keyla Teresa Acosta Torres, Daniela Alves da Quinta, Elsa Alcoba, Isabel Alonso, Nora Artagaveytia, Renata Binato, Alicia Inés Bravo, Felipe Bustos-Rodriguez, Natalia Carnejo, Dirce María Carraro, Mónica Castro, Sandra Cataldi, Mauricio Cerda, Marcia Maria Chiquitelli Marques Silveira |
| Publication date | July 2026 |
| Abstract |
Background How treatment shapes survival after breast-cancer recurrence in Latin America remains poorly described. We extended follow-up of the Latin American Cancer Research Network cohort to quantify postrecurrence overall survival, describe systemic-therapy pathways, and assess the robustness of survival estimates to incomplete follow-up. \n\n Methods We conducted a cohort study of women enrolled with stage I-III breast cancer at 31 centres in Argentina, Brazil, Chile, Mexico, and Uruguay between 2011 and 2014. Vital status and systemic treatments were updated from medical records to July 1, 2025. The main outcome was overall survival after recurrence, defined from first recurrence to death from any cause or censoring. Kaplan-Meier curves and log-rank tests compared survival by immunohistochemistry-defined subtype. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with a Firth-penalised Cox model. Sensitivity analyses included best-case and worst-case censoring, inverse-probability-of-censoring weighting, and Fine-Grey competing-risk regression. Systemic-therapy sequences were reconstructed for up to six lines. \n\n Findings Vital status was updated for 970 of 1191 women (81.4%), and 162 had a documented first recurrence. Median overall survival after recurrence was 24.0 months (IQR 9.6-45.6). Compared with triple-negative breast cancer, adjusted HRs were 0.64 (95% CI 0.20-1.77) for hormone receptor-negative/HER2-positive disease, 0.54 (0.26-1.14) for hormone receptor-positive/HER2-negative disease, and 0.93 (0.39-2.20) for hormone receptor- positive/HER2-positive disease. Chemotherapy was the first-line regimen in 83 of 162 patients (51%), endocrine monotherapy in 55 of 162 (34%), and trastuzumab-pertuzumab-taxane or cyclin-dependent kinase 4 and 6 inhibitor-based regimens in eight of 162 (5%). Overall, 87 of 162 patients (54%) initiated second-line therapy. \n\n Interpretation Adjusted subtype HRs were imprecise and should be interpreted cautiously. Steep treatment-line attrition, limited uptake of contemporary targeted therapies, and incomplete follow-up in some health-system settings indicate modifiable regional gaps in metastatic breast-cancer care. |
| Pages | article 101485 |
| Volume | 59 |
| Journal name | The Lancet Regional Health - Americas |
| Publisher | Elsevier Science (Amsterdam, The Netherlands) |
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