Stage IV breast cancer in the era of targeted therapy

Stage IV breast cancer in the era of targeted therapy

BACKGROUND: Multiple studies have suggested that resection of the primary tumor improves survival in patients with stage IV breast cancer, yet in the era of targeted therapy, the relation between surgery and tumor molecular subtype is unknown. The objective of the current study was to identify subse...

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Veröffentlicht in:Cancer 2010-03, Vol.116 (5), p.1226-1233
Hauptverfasser: Neuman, Heather B., Morrogh, Mary, Gonen, Mithat, Van Zee, Kimberly J., Morrow, Monica, King, Tari A.
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local control
metastatic breast cancer
primary tumor
surgery
survival
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container_end_page 1233
container_issue 5
container_start_page 1226
container_title Cancer
container_volume 116
creator Neuman, Heather B.
Morrogh, Mary
Gonen, Mithat
Van Zee, Kimberly J.
Morrow, Monica
King, Tari A.
description BACKGROUND: Multiple studies have suggested that resection of the primary tumor improves survival in patients with stage IV breast cancer, yet in the era of targeted therapy, the relation between surgery and tumor molecular subtype is unknown. The objective of the current study was to identify subsets of patients who may benefit from primary tumor treatment and assess the frequency of local disease progression. METHODS: Patients presenting with stage IV breast cancer and intact primary tumors (n = 186) were identified from a prospectively maintained clinical database (2000‐2004) and clinical data were ed (grading determined according to the American Joint Committee on Cancer staging system). RESULTS: Surgery was performed in 69 (37%) patients: 34 (49%) patients with unknown metastatic disease at the time of surgery, 15 (22%) patients for local control, 14 (20%) patients for palliation, and in 6 (9%) patients to obtain tissue. Surgical patients were more likely to be HER‐2/neu negative (P = .001), and to have smaller tumors (P = .05) and solitary metastasis (P
doi_str_mv 10.1002/cncr.24873
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The objective of the current study was to identify subsets of patients who may benefit from primary tumor treatment and assess the frequency of local disease progression. METHODS: Patients presenting with stage IV breast cancer and intact primary tumors (n = 186) were identified from a prospectively maintained clinical database (2000‐2004) and clinical data were ed (grading determined according to the American Joint Committee on Cancer staging system). RESULTS: Surgery was performed in 69 (37%) patients: 34 (49%) patients with unknown metastatic disease at the time of surgery, 15 (22%) patients for local control, 14 (20%) patients for palliation, and in 6 (9%) patients to obtain tissue. Surgical patients were more likely to be HER‐2/neu negative (P = .001), and to have smaller tumors (P = .05) and solitary metastasis (P &lt;.001). Local therapy included axillary lymph node clearance in 33 (48%) patients and postoperative radiotherapy in 9 (13%) patients. The median survival was 35 months. Cox regression analysis identified estrogen receptor (ER) positivity (hazard ratio [HR], 0.47; 95% confidence interval [95% CI], 0.29‐0.76), progesterone receptor (PR) positivity (HR, 0.57; 95% CI, 0.36‐0.90), and HER‐2/neu amplification (HR, 0.51; 95% CI, 0.34‐0.77) as being predictive of improved survival. There was a trend toward improved survival with surgery (HR, 0.71; 95% CI, 0.47‐1.06). On exploratory analyses, surgery was found to be associated with improved survival in patients with ER/PR positive or HER‐2/neu‒amplified disease (P = .004). No survival benefit was observed in patients with triple‐negative disease. CONCLUSIONS: Although a trend toward improved survival with surgery was observed, it was noted most strongly in patients with ER/PR positive and/or HER‐2/neu‒amplified disease. This suggests that the impact of local control is greatest in the presence of effective targeted therapy, and supports the need for further study to define patient subsets that will benefit most. Cancer 2010. © 2010 American Cancer Society. Surgical resection of the primary tumor was found to be associated with a trend toward improved survival in patients with stage IV breast cancer who were treated entirely in the modern era. This trend was observed most strongly in the subset of patients with estrogen receptor/progesterone receptor positive and/or HER‐2/neu‒amplified disease and suggests that the impact of local control is most evident in the presence of effective targeted therapy.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.24873</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>local control ; metastatic breast cancer ; primary tumor ; surgery ; survival</subject><ispartof>Cancer, 2010-03, Vol.116 (5), p.1226-1233</ispartof><rights>Copyright © 2010 American Cancer Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1193-da3492f08ad4879456c49ec288a5eaddde2ec59d56b7c3f28c5a11f7b4e3a8f93</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.24873$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.24873$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids></links><search><creatorcontrib>Neuman, Heather B.</creatorcontrib><creatorcontrib>Morrogh, Mary</creatorcontrib><creatorcontrib>Gonen, Mithat</creatorcontrib><creatorcontrib>Van Zee, Kimberly J.</creatorcontrib><creatorcontrib>Morrow, Monica</creatorcontrib><creatorcontrib>King, Tari A.</creatorcontrib><title>Stage IV breast cancer in the era of targeted therapy</title><title>Cancer</title><description>BACKGROUND: Multiple studies have suggested that resection of the primary tumor improves survival in patients with stage IV breast cancer, yet in the era of targeted therapy, the relation between surgery and tumor molecular subtype is unknown. The objective of the current study was to identify subsets of patients who may benefit from primary tumor treatment and assess the frequency of local disease progression. METHODS: Patients presenting with stage IV breast cancer and intact primary tumors (n = 186) were identified from a prospectively maintained clinical database (2000‐2004) and clinical data were ed (grading determined according to the American Joint Committee on Cancer staging system). RESULTS: Surgery was performed in 69 (37%) patients: 34 (49%) patients with unknown metastatic disease at the time of surgery, 15 (22%) patients for local control, 14 (20%) patients for palliation, and in 6 (9%) patients to obtain tissue. Surgical patients were more likely to be HER‐2/neu negative (P = .001), and to have smaller tumors (P = .05) and solitary metastasis (P &lt;.001). Local therapy included axillary lymph node clearance in 33 (48%) patients and postoperative radiotherapy in 9 (13%) patients. The median survival was 35 months. Cox regression analysis identified estrogen receptor (ER) positivity (hazard ratio [HR], 0.47; 95% confidence interval [95% CI], 0.29‐0.76), progesterone receptor (PR) positivity (HR, 0.57; 95% CI, 0.36‐0.90), and HER‐2/neu amplification (HR, 0.51; 95% CI, 0.34‐0.77) as being predictive of improved survival. There was a trend toward improved survival with surgery (HR, 0.71; 95% CI, 0.47‐1.06). On exploratory analyses, surgery was found to be associated with improved survival in patients with ER/PR positive or HER‐2/neu‒amplified disease (P = .004). No survival benefit was observed in patients with triple‐negative disease. CONCLUSIONS: Although a trend toward improved survival with surgery was observed, it was noted most strongly in patients with ER/PR positive and/or HER‐2/neu‒amplified disease. This suggests that the impact of local control is greatest in the presence of effective targeted therapy, and supports the need for further study to define patient subsets that will benefit most. Cancer 2010. © 2010 American Cancer Society. Surgical resection of the primary tumor was found to be associated with a trend toward improved survival in patients with stage IV breast cancer who were treated entirely in the modern era. 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The objective of the current study was to identify subsets of patients who may benefit from primary tumor treatment and assess the frequency of local disease progression. METHODS: Patients presenting with stage IV breast cancer and intact primary tumors (n = 186) were identified from a prospectively maintained clinical database (2000‐2004) and clinical data were ed (grading determined according to the American Joint Committee on Cancer staging system). RESULTS: Surgery was performed in 69 (37%) patients: 34 (49%) patients with unknown metastatic disease at the time of surgery, 15 (22%) patients for local control, 14 (20%) patients for palliation, and in 6 (9%) patients to obtain tissue. Surgical patients were more likely to be HER‐2/neu negative (P = .001), and to have smaller tumors (P = .05) and solitary metastasis (P &lt;.001). Local therapy included axillary lymph node clearance in 33 (48%) patients and postoperative radiotherapy in 9 (13%) patients. The median survival was 35 months. Cox regression analysis identified estrogen receptor (ER) positivity (hazard ratio [HR], 0.47; 95% confidence interval [95% CI], 0.29‐0.76), progesterone receptor (PR) positivity (HR, 0.57; 95% CI, 0.36‐0.90), and HER‐2/neu amplification (HR, 0.51; 95% CI, 0.34‐0.77) as being predictive of improved survival. There was a trend toward improved survival with surgery (HR, 0.71; 95% CI, 0.47‐1.06). On exploratory analyses, surgery was found to be associated with improved survival in patients with ER/PR positive or HER‐2/neu‒amplified disease (P = .004). No survival benefit was observed in patients with triple‐negative disease. CONCLUSIONS: Although a trend toward improved survival with surgery was observed, it was noted most strongly in patients with ER/PR positive and/or HER‐2/neu‒amplified disease. This suggests that the impact of local control is greatest in the presence of effective targeted therapy, and supports the need for further study to define patient subsets that will benefit most. Cancer 2010. © 2010 American Cancer Society. Surgical resection of the primary tumor was found to be associated with a trend toward improved survival in patients with stage IV breast cancer who were treated entirely in the modern era. This trend was observed most strongly in the subset of patients with estrogen receptor/progesterone receptor positive and/or HER‐2/neu‒amplified disease and suggests that the impact of local control is most evident in the presence of effective targeted therapy.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><doi>10.1002/cncr.24873</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects local control
metastatic breast cancer
primary tumor
surgery
survival
title Stage IV breast cancer in the era of targeted therapy
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