Abstract
BackgroundIt is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer. The purpose of this study is to evaluate the survival improvement of patients with recurrent breast cancer after the introduction of third generation aromatase inhibitors (AIs) and trastuzumab.MethodsA total of 407 patients who received first diagnosis of recurrent breast cancer and treatment at National Kyushu Cancer Center between 1992 and 2008 were retrospectively evaluated. As AIs and trastuzumab were approved for clinical use in Japan in 2001, the patients were divided into two time cohorts depending on whether the cancer recurred before or after 2001. Cohort A: 170 patients who were diagnosed between 1992 and 2000. Cohort B: 237 patients who were diagnosed between 2001 and 2008. Tumor characteristics, treatments, and outcome were compared.ResultsFourteen percent of cohort A and 76% of cohort B received AIs and/or trastuzumab (P < 0.001). The median overall survival (OS) times after breast cancer recurrence were 1.7 years and 4.2 years for these respective cohorts (P < 0.001). Both the time period and treatment of AIs and/or trastuzumab for recurrent disease were significant prognostic factors in multivariate analysis (cohort B vs. cohort A: HR = 0.70, P = 0.01; AIs and/or trastuzumab for recurrent disease: yes vs. no: HR = 0.46, P < 0.001). When patients were categorized into 4 subgroups by the expression of hormone receptor (HR) and HER-2 status, the median OS times of the HR-positive/HER-2-negative, HR-positive/HER-2-positive, HR-negative/HER-2-positive, and HR-negative/HER-2-negative subtypes were 2.2, 2.4, 1.6, and 1.0 years in cohort A and 4.5, 5.1, 5.0, and 1.4 years in cohort B.ConclusionsThe prognosis of patients with recurrent breast cancer was improved over time following the introduction of AIs and trastuzumab and the survival improvement was apparent in HR- and/or HER-2-positive tumors.
Highlights
It is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer
While it is difficult to ascertain exactly which therapies have contributed to the improved survival of patients with advanced breast cancer [13], the improvement does seem to be associated with the expression of certain biological factors
It has been shown that the use of trastuzumab is still effective when continued beyond disease progression [21] and that a change to a different aromatase inhibitors (AI) is effective after the failure of another AI [22]; we decided to include these patients in this analysis
Summary
It is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer. Compared with the adjuvant setting, the type of tailored treatments (based on biological factors) that have contributed to the improvement in prognosis for patients with recurrent or advanced breast cancer is less clear. Andre et al (2004) compared the prognosis of metastatic breast cancer patients over two time periods, and showed a significant prolongation of survival over time in patients with HR-positive tumors [14]. This finding suggests that the improvement was related to therapy targeted at patients who had HR-positive tumors. We investigate whether the survival of women with recurrent breast cancer has improved following the introduction of new agents, such as AIs and trastuzumab. We compared the prognosis between patients first diagnosed with recurrent breast before 2001 and those first diagnosed after 2001
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