Metastatic breast cancer: prolongation of survival in routine care is restricted to hormone-receptor- and Her2-positive tumors.

Rudolf Weide,Kristina Kleboth,Jochen Heymanns,Christoph Van Roye,Vera Friesenhahn,Hubert Köppler,Stefan Feiten,Jörg Thomalla

doi:10.1186/2193-1801-3-535

Abstract

18,000 women die due to metastatic breast cancer in Germany per year. Median survival is 20–28 months after diagnosis. The question we wanted to answer was whether survival has improved in routine care? For this purpose we conducted a retrospective analysis of all patients with metastatic breast cancer who were treated between 06/1995-06/2013 in a community-based oncology group practice in Germany. 716 patients were analyzed with a median age of 61 (31–93). Localizations of metastases were distributed as follows: 47% visceral, 36% bone, 9% lymphatic, 4% CNS, 4% others. 79% were hormone-receptor-positive, 20% Her2-positive, 9% triple-negative. Median overall survival was 34 months (95% Confidence Interval: 31–37), median disease-specific survival 36.8 months and disease-specific survival after 5 years 34%. Survival was significantly correlated with localizations of metastases, number of metastasized organs, disease free survival since initial diagnosis, hormone-receptor status and age. Patients with hormone-receptor-positive tumors had a median overall survival of 37 months, Her2-positive patients of 34 months and triple-negative patients of 13 months. 86% of hormone-receptor-positive patients received antihormonal therapy. 81% of Her2-positive patients received anti-Her2 therapy. In summary, longer survival is strongly restricted to hormone receptor- and Her2-positive tumors most likely due to targeted therapies directed against the estrogen-receptor and Her2.

Highlights

Metastatic breast cancer is the tumor with the highest mortality in women
First of all patients were classified according to metastatic sites at initial diagnosis as follows: CNS affection, visceral metastasis without CNS affection, regional metastasis of the lymph nodes, bone only metastasis and localizations which could not be classified in this scheme
Our analysis of more than 700 unselected, consecutive patients in routine care confirms a prolongation of survival with a median overall survival of 34 months, a disease-specific survival of 36.8 months and a disease-specific survival of 34% after 5 years

Summary

Introduction

Metastatic breast cancer is the tumor with the highest mortality in women. In Germany about 18,000 women die from breast cancer annually (Statistisches Bundesamt https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/ Gesundheit/Todesursachen/Tabellen/SterbefaelleInsgesamt. html). Tumor registry data from the Saarland and from Munich imply that the survival of patients with metastatic breast cancer has not improved in the last 20–30 years in Germany (Holleczek et al 2011; Schlesinger-Raab et al 2005). Contradictory publications are available from other tumor registries and other institutions that describe a survival improvement in routine care (Mauri et al 2008; Gennari et al 2005; Giordano et al 2004; Chia et al 2007; Tai et al 2004; Dafni et al 2010; Allemani et al 2013; Weide et al 2009). This improvement in survival is causally attributed by the authors to the introduction of new drugs (cytostatic agents, antihormonal therapy and anti-Her therapies) (Mauri et al 2008; Gennari et al 2005; Giordano et al 2004; Chia et al 2007; Dafni et al 2010; Allemani et al 2013; Weide et al 2009)

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