Abstract
BackgroundData that directly associate utilization of novel systemic therapies with survival trends in metastatic breast cancer (MBC) are limited. In the setting of de novo MBC, large registry analyses cite positive temporal trends in survival, but the extent to which advances in systemic therapy have contributed to these gains is not clear.MethodsThe City of Hope Cancer Registry was used to identify a consecutive series of patients with de novo MBC who received their first line of therapy between 1985 and 2004. Comprehensive clinicopathologic and treatment-related data were collected for each patient. Univariate analyses were conducted via Cox regression to identify factors associated with improved survival. Multivariate analysis was also conducted via Cox regression and the stepwise procedure was used to identify independent predictors of survival.ResultsA total of 324 patients with de novo MBC were identified. After application of exclusion criteria, including the sole presence of supraclavicular node metastasis, 274 patients were retained in the analysis. The treatment-related characteristics associated with improved survival included: use of endocrine therapy (hazard ratio [HR] 0.60, 95%CI 0.47-0.77; P<0.0001), and addition of bisphosphonates (HR 0.70, 95%CI 0.52-0.96; P=0.02). However, recipients of novel cytotoxic agents (defined as drugs approved for MBC since 1994) had no improvement in survival relative to patients treated with older cytotoxic agents. On multivariate analysis, age (< 50), receipt of aromatase inhibitors, and receipt of zoledronic acid were independent predictors of survival.ConclusionsThe overall survival of women with de novo metastatic breast cancer has improved over the past 20 years. However, the contribution of conventional cytotoxic agents to this improvement is minimal.
Highlights
Data that directly associate utilization of novel systemic therapies with survival trends in metastatic breast cancer (MBC) are limited
Among the clinicopathologic factors assessed, only estrogen receptor (ER) status was significantly associated with improved survival
Treatment with endocrine therapy was associated with an improvement in survival (HR=0.60, 95%CI 0.47-0.77; P
Summary
Data that directly associate utilization of novel systemic therapies with survival trends in metastatic breast cancer (MBC) are limited. In addition to earlier detection, the use of adjuvant chemotherapy and endocrine therapy following definitive surgery and radiation therapy is credited with a significant improvement in overall survival. These same systemic therapies that prolong the survival of women with early stage disease are only palliative in metastatic disease. For women with metastatic HER2 positive breast cancers, Since 1994, a number of agents have been shown to be active in advanced breast cancer. These include: paclitaxel, docetaxel, capecitabine, vinorelbine, gemcitabine, nab-paclitaxel, and ixabepilone [3]. The recent debate about the use of bevacizumab in breast cancer has forced us to re-evaluate the risk benefit ratio of our interventions and to question if prolongation in overall survival is a realistic benchmark for all new agents [4]
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