Chemotherapy of Metastatic Breast Cancer: What to Expect in 2001 and Beyond

Esteva, Francisco J.; Valero, Vicente; Pusztai, Lajos; Boehnke-Michaud, Laura; Buzdar, Aman U.; Hortobágyi, Gabriel N.

doi:10.1634/theoncologist.6-2-133

Cited by 137 publications

(79 citation statements)

References 74 publications

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“…In patients with metastatic breast cancer, skeletal involvement is very frequent, with an incidence of 47-85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31,43]. Among reported clinical series of spinal epidural metastases, breast cancer is again common, accounting for 9-40% of all cases [11, 20, 22, 24, 28, 44-47, 49, 50].…”

Section: Discussionmentioning

confidence: 99%

“…Medical therapies include systemic chemotherapy/hormonal therapy and medications specific for spinal metastases, such as steroids, analgesics, and bisphosphonates [6,12,31,34,41]. Bisphosphonates are highly effective in reducing bone pain, hypercalcemia and pathological fractures, and they are frequently used at our institutions [23,30,31].…”

Section: Discussionmentioning

confidence: 99%

“…In North American and Western European women, carcinoma of the breast is the most common malignancy and the second most common cause of cancer-related death [7,12,21]. In women with metastatic breast cancer, skeletal involvement is very frequent, with reported incidences between 47 and 85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31].…”

Section: Introductionmentioning

confidence: 99%

“…In women with metastatic breast cancer, skeletal involvement is very frequent, with reported incidences between 47 and 85% in autopsy series and 69-80% when defined radiographically [7,12,16,21,31]. About onethird of these spinal metastases become symptomatic, causing intractable pain, neurological deficits, and/or biomechanical instability requiring surgical treatment [19,34].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre-and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory.Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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“…In the management of patients with metastatic disease, chemotherapy may offer effective palliation, and anthracyclines are widely recognised as the most active drugs (Esteva et al, 2001;Crown et al, 2002). The widespread use of these agents in the adjuvant setting, however, limits their employment in disease recurrence, thus demanding the testing of new effective regimens.…”

mentioning

confidence: 99%

Paclitaxel, vinorelbine and 5-fluorouracil in breast cancer patients pretreated with adjuvant anthracyclines

Berruti¹,

Bitossi²,

Gorzegno³

et al. 2005

Br J Cancer

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We investigated the activity and toxicity of a combination of vinorelbine (VNB), paclitaxel (PTX) and 5-fluorouracil (5-FU) continuous infusion administered as first-line chemotherapy in metastatic breast cancer patients pretreated with adjuvant anthracyclines. A total of 61 patients received a regimen consisting of VNB 25 mg m À2 on days 1 and 15, PTX 60 mg m À2 on days 1, 8 and 15 and continuous infusion of 5-FU at 200 mg m À2 every day. Cycles were repeated every 28 days. Disease response was evaluated by both RECIST and World Health Organization (WHO) criteria. Objective responses were recorded in 39 of 61 patients (64.0%) assessed by WHO and in 36 of 50 patients (72.0%) assessable by RECIST criteria. Complete remission occurred in 15 (24.6%) and 14 patients (28.0%), respectively. The median time to progression and overall survival of entire population was 10.6 and 27.3 months, respectively, and median duration of complete response was 14.8 months. The dose-limiting toxicity was myelosuppression (leucopenia grade 3/4 in 52.5% of patients). Grade 3/4 nonhaematologic toxicities included mucositis/diarrhoea in 13.1%, skin in 3.3% and cardiac in 1.6% of patients. Grade 2/3 neurotoxicity was observed in five patients (7.2%). The VNB, PTX and 5-FU continuous infusion combination regimen was active and manageable. Complete responses were frequent and durable.

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