The treatment of patients with metastatic breast cancer (mBC) is one of the most difficult problems in clinical oncology. Clinical trial results suggest that novel therapies may be having a favorable impact on the survival of mBC patients, but the real impact of new therapies on OS rates has yet to be established. The aim of this outcome study was to evaluate the most reliable parameters to define the long-term result in terms of OS of different treatment strategies for mBC patients in a real-world clinical practice.
Materials and Methods
A retrospective analysis of consecutive patients diagnosed with mBC between February 2001 and December 2008 and treated at our medical oncology unit was performed.
Results
We evaluated 70 female patients. At the last follow-up all patients had died. Median OS was 31.55 months (range, 2.33-100.13). There was no statistically significant difference in OS (p = 0.284) between the period 2001-2004 and the period 2005-2008. We did not find any statistically significant difference in OS even in the transition from one year to the next (p = 0.154).
Conclusions
The results of the current analysis suggest that the OS of women with mBC has not improved in the last years. However, these results should be interpreted with caution, considering the difficulty of determining changes in survival over time. Larger studies are needed to corroborate our findings.
O'ShaughnessyJ.Extending survival with chemotherapy in metastatic breast cancer. Oncologist.2005; 10(Suppl 3): 20–29.
2.
JohnstonS.R.The role of chemotherapy and targeted agents in patients with metastatic breast cancer. Eur J Cancer.2011; 47(Suppl 3): S38–S47.
3.
HendersonI.C., BerryD.A., DemetriG.D.Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol.2003; 21(6): 976–983.
4.
GhersiD., WilckenN., SimesJ., DonoghueE.: Taxane containing regimens for metastatic breast cancer. Cochrane Database Syst Rev.2003; 3: CD003366.
5.
SlamonD.J., Leyland-JonesB., ShakS.Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med.2001; 344(11): 783–792.
6.
BonadonnaG., BrusamolinoE., ValagussaP.Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med.1976; 294(8): 405–410.
7.
FisherB., CarboneP., EconomouS.G.1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. A report of early findings. N Engl J Med.1975; 292(3): 117–122.
8.
Piccart-GebhartM.J., ProcterM., Leyland-JonesB.; Herceptin Adjuvant (HERA) Trial Study Team. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med.2005; 353(16): 1659–1672.
9.
GiordanoS.H., BuzdarA.U., SmithT.L., KauS.W., YangY., HortobagyiG.N.Is breast cancer survival improving?Cancer.2004; 100(1): 44–52.
10.
LumachiF., BassoS.M.M., BrandesA.A., PaganoD., ErmaniM.Relationship between tumor markers CEA and CA 15-3, TNM staging, estrogen receptor rate and MIB-1 index in patients with pT1-2 breast cancer. Anticancer Res.2004; 24(5B): 3221–3224.
11.
Incidenza dei tumori in Italia: stime per il 2006. Epidemiologia e Prevenzione.2006; Suppl 2: 105–106.
12.
InsaA., LluchA., ProsperF., MaruganI., Martinez-AgulloA., Garcia-CondeJ.Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat.1999; 56(1): 67–78.
13.
AsgeirssonK.S., McCulleyS.J., PinderS.E., MacmillanR.D.Size of invasive breast cancer and risk of local recurrence after breast-conservation therapy. Eur J Cancer.2003; 39(17): 2462–2469.
14.
PiccartM.J.Proposed treatment guidelines for HER2-positive metastatic breast cancer in Europe. Ann Oncol.2001; 12(Suppl 1): S89–S94.
15.
EllisM.J., CoopA., SinghB.Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol.2001; 19(18): 3808–3816.
16.
BursteinH.J., HarrisL.N., MarcomP.K.Trastuzumab and vinorelbine as first-line therapy for HER2-overexpressing metastatic breast cancer: multicenter phase II trial with clinical outcomes, analysis of serum tumor markers as predictive factors, and cardiac surveillance algorithm. J Clin Oncol.2003; 21(15): 2889–2895.
17.
AlbaE., RibellesN., SevillaI.Adjuvant anthracycline therapy as a prognostic factor in metastatic breast cancer. Breast Cancer Res Treat.2001; 66(1): 33–39.
18.
KornegoorR., Verschuur-MaesA.H., BuergerH.Molecular subtyping of male breast cancer by immunohistochemistry. Mod Pathol.2012; 25(3): 398–404.
19.
MilesD., von MinckwitzG., SeidmanA.D.Combination versus sequential single-agent therapy in metastatic breast cancer. Oncologist.2002; 7(Suppl 6): 13–19.
20.
GreenbergP.A., HortobagyiG.N., SmithT.L., ZieglerL.D., FryeD.K., BuzdarA.U.Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol.1996; 14(8): 2197–2205.
21.
FossatiR., ConfalonieriC., TorriV.Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women. J Clin Oncol.1998; 16(10): 3439–3460.
22.
PiergaJ.Y., RobainM., JouveM.Response to chemotherapy is a major parameter-influencing long-term survival of metastatic breast cancer patients. Ann Oncol.2001; 12(2): 231–237.
23.
BruzziP., Del MastroL., SormaniM.P.Objective response to chemotherapy as a potential surrogate end point of survival in metastatic breast cancer patients. J Clin Oncol.2005; 23(22): 5117–5125.
24.
ChiaS.K., SpeersC., KangA.The impact of new chemotherapeutic and hormonal agents on the survival of women with metastatic breast cancer in a population based cohort. Proc Am Soc Clin Oncol.2003; 22: 6 (abstr. 22).
25.
ChiaS.K., SpeersC.H., D'yachkovaY.The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer.2007; 110(5): 973–979.
26.
AbrialC., LeheurteurM., CabrespineA.Does survival increase in metastatic breast cancer with recently available anticancer drugs?Oncol Res.2006; 15(9): 431–439.
27.
RobertN.J.Overall survival in metastatic breast cancer: always our quest but not necessarily a primary endpoint. Breast Cancer Res Treat.2010; 122(1): 9–10.
CortazarP., ZhangJ.J., SridharaR., JusticeR.L., PazdurR.; US Food and Drug Administration. Relationship between OS and PFS in metastatic breast cancer (MBC): review of FDA submission data. J Clin Oncol.2011; 29(suppl): abstr 1035.
