Impact of modern chemotherapy on the survival of women presenting with de novo metastatic breast cancer

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.

Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States

“…Other studies have also shown improvement in survival for women with de novo distant disease or metastatic recurrence(16–18), attributed to improved treatment. The improvement in MBC survival may also be explained by changes in staging.…”

Predicting Survival of De Novo Metastatic Breast Cancer in Asian Women: Systematic Review and Validation Study

“…The use of endocrine therapy and anti-HER2 drugs has been shown to prolong survival of metastatic patients [54], [55], [56]. Many randomized control trials have also reported significant survival benefit from modern chemotherapeutic agents, such as taxanes [57].…”

Survivorship and the chronic cancer patient: Patterns in treatment‐related effects, follow‐up care, and use of survivorship care plans

“…Nearly 14.5 million cancer survivors are living in the United States today, with this number projected to increase to 19 million by 2024 . Although there are no precise estimates of how many of these survivors are living with chronic cancer (CC), we can expect this population to grow as advances in treatments and supportive care expand our capacity to control and manage CC patients for long periods of time, even when a cure may not be possible …”

“…3 Although there are no precise estimates of how many of these survivors are living with chronic cancer (CC), we can expect this population to grow as advances in treatments and supportive care expand our capacity to control and manage CC patients for long periods of time, even when a cure may not be possible. [3][4][5][6] Survivorship care plans (SCPs) were introduced by the Institute of Medicine in 2005 as documents that summarize a survivor's cancer history and establish a follow-up plan beyond active treatment with the intent of facilitating communication and assigning responsibilities across treatment teams, caregivers, and survivors themselves. 7,8 The use of SCPs for patients living with CC has not yet been embraced by the medical community, as illustrated by their exclusion from the American College of Surgeons Commission on Cancer standards for SCPs, and it remains a neglected topic of research.…”