Ten-year subtype survival and systemic–therapy pathways analysis after breast-cancer recurrence in the LACRN MPBC multicountry cohort study

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 post-recurrence overall survival, describe systemic-therapy pathways, and assess the robustness of survival estimates to incomplete follow-up. 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. 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. 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. Funding: ASCO Conquer Cancer & Pfizer Competitive Grant for Quality Improvement (contract award No. 87534309); Center for Global Health at the United States-National Cancer Institute at the National Institutes of Health (contract award No. HHSN2612010000871/NO2-PC-2010-00087); Fogarty International Center, NIH, HHS; and Susan G. Komen for the Cure; in Argentina, Instituto Nacional del Cáncer (Ministry of Health), Fundación Argentina de Nanotecnología, Agencia Nacional de Promoción Científica y Tecnológica, CONICET (Ministry of Science, Technology, and Productive Innovation); Brazil, Ministério da Saúde (Ministry of Health); Chile, Instituto de Salud Pública (Public Health Institute) and Ministerio de Salud (Ministry of Health); and Mexico, Consejo Estatal de Ciencia y Tecnología de Jalisco (COECYTJAL) and Universidad de Sonora (University of Sonora).

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Journal
The Lancet Regional Health - Americas
Published
2026-05-01
DOI
https://doi.org/10.1016/j.lana.2026.101485
Primary Topic
Breast Cancer Treatment Studies
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article
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article

Ten-year subtype survival and systemic–therapy pathways analysis after breast-cancer recurrence in the LACRN MPBC multicountry cohort study

Antônio Hugo José Fróes Marques Campos, Fernando Carrizo, Antonio Oceguera‐Villanueva, Graciela Acosta et al.
The Lancet Regional Health - Americas
Breast Cancer Treatment Studies
article

Ten-year subtype survival and systemic–therapy pathways analysis after breast-cancer recurrence in the LACRN MPBC multicountry cohort study

Antônio Hugo José Fróes Marques Campos, Fernando Carrizo, Antonio Oceguera‐Villanueva, Graciela Acosta, Michael Villalobos, Viviane Andrade, André Lopes Carvalho, Adelfo Barragán-Ruiz, Soledad Cano, Dirce Maria Carraro, Alejandra Trinchero, Marta Vilensky, Sebastián Astorga, Javier Retamales, Carlos Velázquez, Marcia Maria Chiquitelli Marques Silveira, Rodrigo Assar, F. Argandoña, Alicia Del Toro‐Arreola, Marta Aghazarian, Gabriela Acosta Haab, Gonzalo Ardao, Alicia Bravo, Ricardo Armisén, Belén Valenzuela, Renata Binato, Cristina Rosales, Livia Zagamé, Daniela Alves da Quinta, Ingiborg Araya, Mariana Savignano, A. Álvarez, Miguel Angel Bustamante, Rafael Cantón, Antonio Quintero-Ramos, Eliana Abdelhay, Felipe de J. Bustos-Rodriguez, Fancy Gaete, Andrea S. Llera, Ma Isabel Aramburo Rubio, Monica Castro, Antônio Bailão Junior, Zdenka Zlatar, Fernanda Bermudez, Claudia Arias, Andrés Moran-Mendoza, Susanne Crocamo, Liz Almeida, Bernardo Aizen, Erika Saavedra, Erika Carvallo, Mauricio Cerda, Maxwell Aviles Rodriguez, Claudio Bustamante, Bettina Müller, Janett Caballero Jasso, Wenceslao Angeles-Bueno, Angie Calfuman, Ramon Franco-Topete, Alejandra Lopez-Vazquez, Veronica Sanchotena, Adrian Daneri-Navarro, Jorge Gomez, Paulina Carmona, Mónica Campos, Elsa Alcoba, Keyla Teresa Acosta Torres, Mauricio Aspee, Roberto Arai, Rafael Tejeda-Moctezuma, Juan Abarca, Maria Aparecida Nagai, Gustavo Alarcon Lopez, Lilia A. Arellano-Jimenez, Mara Bonet, Osvaldo Podhajcer, Natalia Camejo, Rocio Guerra, Claudia Sierra, Adolfo E. Barragan-Curiel, Sandra Cataldi, Ana Carolina Alves de Andrade Silva, Nora Artagaveytia, Gissel Acosta, Isabel Alonso, Itzel Reneé Astiazarán Rascón, Julio Bustos-Gomez, Priscila Elvira Arambula Barreras, Julio Carzoglio, Adrián Hannois, Carola Aguayo, Sarah Brnich, Pamela Acevedo, Ricardo Cappetta, Oriana Seguel, Julia Bernachin, Estrellita Araus, Wilfrido Bernal Herrera
article en

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 post-recurrence overall survival, describe systemic-therapy pathways, and assess the robustness of survival estimates to incomplete follow-up. 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. 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. 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. Funding: ASCO Conquer Cancer & Pfizer Competitive Grant for Quality Improvement (contract award No. 87534309); Center for Global Health at the United States-National Cancer Institute at the National Institutes of Health (contract award No. HHSN2612010000871/NO2-PC-2010-00087); Fogarty International Center, NIH, HHS; and Susan G. Komen for the Cure; in Argentina, Instituto Nacional del Cáncer (Ministry of Health), Fundación Argentina de Nanotecnología, Agencia Nacional de Promoción Científica y Tecnológica, CONICET (Ministry of Science, Technology, and Productive Innovation); Brazil, Ministério da Saúde (Ministry of Health); Chile, Instituto de Salud Pública (Public Health Institute) and Ministerio de Salud (Ministry of Health); and Mexico, Consejo Estatal de Ciencia y Tecnología de Jalisco (COECYTJAL) and Universidad de Sonora (University of Sonora).

The Lancet Regional Health - AmericasVol. 59
Consejo Nacional de Investigaciones Científicas y Técnicas (AR), Mexican Social Security Institute (MX), Universidad de Guadalajara (MX), Centro Hospitalario Pereira Rossell (UY), Fundación Instituto Leloir (AR), AC Camargo Hospital (BR), Universidad de Sonora (MX), Instituto do Câncer do Estado de São Paulo (BR), Hospital de Câncer de Barretos (BR), Hospital Barros Luco-Trudeau (CL), Instituto de Desarrollo Tecnológico para la Industria Química (AR), Texas A&M Health Science Center (US), Hospital Santiago Oriente - Dr. Luis Tisne Brousse (CL), Hospital Civil de Guadalajara (MX), Fundación Arturo López Pérez (CL), Complejo Asistencial Sótero del Río (CL), Instituto Jalisciense de Cancerología (MX), Instituto Nacional de Câncer - INCA (BR), Instituto Nacional del Cáncer (CL), Instituto de Oncología de Rosario (AR), Hospital de Clínicas (UY), Hospital San Borja Arriarán (CL), Universidad Argentina de la Empresa (AR), University of Chile (CL)
Conquer Cancer Foundation
Openalex Percentile: Top 11%
Breast Cancer Treatment Studies
DOIOpen Access PDFOpenAlex
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