Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review

Khan, Seema A.; Schuetz, Steven; Husseini, Omid

doi:10.1245/s10434-022-11900-x

Cited by 4 publications

(5 citation statements)

References 55 publications

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“…First, the rationale for tumour debulking is to reduce the global tumour burden, thus increasing the efficacy of systemic therapy; second, removal of the primary tumour could reduce tumour-related immunosuppression and stimulate the immune response of the host and could reduce the source of cancer stem cells, which have been associated with the emergence of resistance to therapy and which may lead to more aggressive disease. 80 In contrast, some argue that the primary tumour may be a source of antiangiogenic factors and growth factor inhibitors; therefore, its removal may lead to a more rapid relapse. Finally, other potential drawbacks may be related to the release of growth factors associated with the surgical wound and to immunosuppression induced by the surgery itself.…”

Section: Locoregional Treatmentsmentioning

confidence: 99%

“…Finally, other potential drawbacks may be related to the release of growth factors associated with the surgical wound and to immunosuppression induced by the surgery itself. 80…”

Section: Locoregional Treatmentsmentioning

confidence: 99%

“…87 However, the generalization of the results of this study has been questioned because of the imbalance of favourable prognostic factors (HR + tumours, bone-only disease) between arms and in comparison with other trials. 80 A subsequent study from the same group prospectively investigated the sequence between systemic therapy and surgery in patients with bone-only dnMBC. 88 This prospective registry study included 505 patients who received upfront systemic therapy (240 patients) or surgery (265 patients); patients in the latter group could receive local treatment before or after systemic therapy.…”

Section: Evidence From Prospective Randomized Trialsmentioning

confidence: 99%

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HR+/HER2– de novo metastatic breast cancer: a true peculiar entity?

Torrisi¹,

Jacobs²,

Miggiano³

et al. 2023

DIC

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De novo metastatic breast cancer (dnMBC) accounts for ~6-10% of all breast cancers and for ~30% of MBC with increasing incidence over time. Hormone receptor-positive/ human epidermal growth factor receptor 2-negative (HR + /HER2 -) tumours are the most frequent subtype with a similar incidence to that observed amongst recurrent MBC (rMBC). Higher frequency of PI3KCA and ARID2 mutations and a lower frequency of ESR1 mutations and of genes involved in DNA damage, as compared with rMBC, have been reported in HR + /HER2 -dnMBC; however, these are not correlating with prognosis, whilst tumour mutational burden is inversely correlated with outcome. Bone represents the most frequent metastatic site, being the single site in up to 60% of patients with dnMBC. HR + /HER2 -dnMBC has been generally reported to have better outcomes than rMBC, with a median overall survival ranging from 26 months to nearly 5 years in patients with favourable features such as age <40 years and bone-only disease, but not when compared with patients with late recurring disease (≥2-5 years). Analyses of the de novo cohorts within randomized clinical trials and large real-world series report a better outcome after treatment with CDK4/6 inhibitors and endocrine agents as compared to rMBC. Despite the limitations of retrospective studies and controversial results of the randomized trials, locoregional treatment of the primary tumour after response to systemic therapy appears to confer a survival benefit, particularly in patients with favourable prognostic factors. Altogether genomic, biological and clinical findings highlight HR + /HER2 -dnMBC as a peculiar entity as compared with rMBC and deserve a dedicated treatment algorithm.

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Section: Locoregional Treatmentsmentioning

confidence: 99%

“…Finally, other potential drawbacks may be related to the release of growth factors associated with the surgical wound and to immunosuppression induced by the surgery itself. 80…”

Section: Locoregional Treatmentsmentioning

confidence: 99%

Section: Evidence From Prospective Randomized Trialsmentioning

confidence: 99%

See 1 more Smart Citation

HR+/HER2– de novo metastatic breast cancer: a true peculiar entity?

Torrisi¹,

Jacobs²,

Miggiano³

et al. 2023

DIC

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“…We are aware of their peer-reviewed published results, and have discussed these in our JCO manuscript and elsewhere. 9 Soran et al 2 think it is incorrect to suggest that LRT does not provide a survival advantage in dn stage IV BC based on the results of a study with a limited-follow-up (emphasis added). We would like to point out again that median follow-up on E2108 was 53 months, and at the time of analysis, 225 of the 256 patients randomly assigned had been followed for 4.5 years or more since random assignment.…”

mentioning

confidence: 99%

“…We are aware of their peer-reviewed published results, and have discussed these in our JCO manuscript and elsewhere. 9…”

mentioning

confidence: 99%

Reply to B. Ulaş Kahya et al and A. Soran et al

Khan

Zhao

Goldstein

et al. 2022

JCO

Self Cite

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Thank you for the opportunity to respond to correspondences from Ulas ¸Kahya et al 1 and Soran et al 2 regarding our manuscript. 3 We thank both groups for their interesting and detailed questions regarding our recent report on the results of E2108, a phase III trial testing the value of local regional therapy to the primary site in women with newly diagnosed metastatic breast cancer that was resectable following optimal systemic therapy. 3

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Impact of Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer

Makris

Soran

2022

Ann Surg Oncol

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Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review

Cited by 4 publications

References 55 publications

HR+/HER2– de novo metastatic breast cancer: a true peculiar entity?

HR+/HER2– de novo metastatic breast cancer: a true peculiar entity?

Reply to B. Ulaş Kahya et al and A. Soran et al

Impact of Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer

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