Does more intense palliative treatment improve overall survival in metastatic breast cancer patients?

Patel, Jashbhai K.; Nemoto, Takuma; Vezeridis, Michael P.; Petrelli, Nicholas J.; Suh, Okhee; Dao, Thomas L.

doi:10.1002/1097-0142(19860201)57:3<567::aid-cncr2820570328>3.0.co;2-y

Cited by 44 publications

(10 citation statements)

References 7 publications

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“…In contrast it has proved much harder to show that chemotherapy prolongs survival for advanced disease. This dilemma lies at the root of controver- (Paterson et al, 1982;Patel et al, 1986).…”

Section: Discussionmentioning

confidence: 99%

Continuous chemotherapy in responsive metastatic breast cancer: a role for tumour markers?

Dixon

Jackson²,

Chan³

et al. 1993

Br J Cancer

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Summary A biochemical response index comprising ESR, CEA and CA 15.3 was evaluated in 67 patients with systemic breast cancer treated by chemotherapy; 55 were assessable by UICC criteria and the response index (96% of all UICC assessable patients). Marker changes at 2 and 4 months showed a highly significant correlation with the UICC assessed response at 3 and 6 months (P<0.001); sensitivity 100%, specificity 87%; positive predictive value 85%; negative predictive value 100%.This index was then used to select out truly responsive patients and to prospectively direct their chemotherapy. Twenty-six responding (biochemical/clinical) patients were randomised to discontinue cytotoxics after 6 months and move to maintenance hormones (n = 13) or continue chemotherapy whilst the biochemical markers kept falling or remained within the normal range. Biochemical progression prompted a change of chemotherapy. Continuous chemotherapy in biochemically defined responders was associated with a significant lengthening of remission duration and an improved quality of life and survival. We are now using the index to routinely direct chemotherapy and select out true responders for maintenance chemotherapy.As yet there is no single ideal tumour marker for breast cancer and no established role. Combinations of serum markers, including carcinoembryonic antigen (CEA), have been investigated in an attempt to increase the sensitivity of detecting metastases (Franchimont et al., 1976; Coombes et al., 1988;Cowen et al., 1978;Cove et al., 1979). Very few studies have looked at combinations in measuring response to therapy. On retrospective and prospective analyses we have shown that changes in CEA, ESR and CA 15.3 individually correlate with therapeutic response in patients with metastatic breast cancer treated by first-line hormones (Williams et al., 1990;Robertson et al., 1992). In a prospective study, 93% of patients were assessable with a sensitivity for response of 92% and specificity 82% (Robertson et al., 1992). This present study examines the index in patients receiving chemotherapy and describes our experience of using objective biochemical assessment to direct individual patient therapies. (British Breast Group, 1974). Comparisons were made between assessments by UICC criteria with a minimum duration of remission or statis disease of 6 months and the changes in the biochemical markers measured at 6-8 and 12-16 weeks. In analysing the correlation between biochemical marker movement and UICC assessed response, objective responders and static disease were combined into a non-progressive disease group and compared with those patients that showed disease progression. Patients and methods SixtyBiochemical assessment of response The biochemical score was calculated in the same manner as described for the first-line endocrine studies (Williams et al., 1990;Robertson et al., 1992). Namely, any change in marker whilst the patient is on therapy is related to the pretreatment value. A cut-off for each marker of the mean + 2 s.d. of the nor...

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Section: Discussionmentioning

confidence: 99%

Continuous chemotherapy in responsive metastatic breast cancer: a role for tumour markers?

Dixon

Jackson²,

Chan³

et al. 1993

Br J Cancer

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“…Between 1920 and 1980, combination drug programs have become available, yet may not have resulted in dramatic improvement in overall survival (OS) of the MBC patients [8]. OS observed between 1942 and 1975 also showed no significant prolongation of survival time in patients with MBC [9]. We had to wait till the twenty-first century for some hope of a cure to be reported, at least in a portion of the MBC patients [10][11][12].…”

mentioning

confidence: 40%

From improved survival to potential cure in patients with metastatic breast cancer

Kobayashi

2012

Breast Cancer

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“…One of the main prognostic discriminants is the site and number of metastases, which makes it difficult to compare (inter-) national data deriving from different hospitals. Nevertheless, median post-recurrence survival is mostly in the range of 18-24 months (Powles et al, 1980;Patel et al, 1986;Tomin & Donegan, 1987;Perez et al, 1990;Dixon et al, 1991), which strongly resembles our data (20.3 mo). Almost 60% of the women in the three hospitals had received radiation treatment for advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Advanced breast cancer and its prevention by screening

Bm²,

Jc³

et al. 1992

Br J Cancer

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Summary In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources. A random sample of 60 female cases from computerised registries of two cancer centres and a sample of 20 cases from a non-computerised hospital registry was taken. A total of 68 patient files were sufficiently documented. A woman with advanced breast cancer is estimated to have a 39% loss in utility compared to a healthy woman (range 27-45%). Hormonal treatment is the main modality during 14 and chemotherapy during 4 months. Total medical cost from diagnosis of advanced disease until death amounts to 17,100 US dollars, or 21,000 when including extramural cost.The effect of breast cancer screening by preventing the occurrence of advanced disease is quantified. The resulting gain in quality of life contributes 70% of the total gain in quality of life. In the long run, almost half of the annual cost of screening will be offset by savings in the cost for advanced disease. Only the changes in palliative surgery and/or radiotherapy will be small in contrast to primary treatment changes. Besides the mortality reduction, screening is justified by the improvements in quality of life and cost savings for women prevented from reaching advanced disease.

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Does more intense palliative treatment improve overall survival in metastatic breast cancer patients?

Cited by 44 publications

References 7 publications

Continuous chemotherapy in responsive metastatic breast cancer: a role for tumour markers?

Continuous chemotherapy in responsive metastatic breast cancer: a role for tumour markers?

From improved survival to potential cure in patients with metastatic breast cancer

Advanced breast cancer and its prevention by screening

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