Prognostic Subgroups: The Key Factor for Treatment Outcome in Metastatic Breast Cancer

Abstract

Background: Since prolongation of survival by chemotherapy has been questioned, palliation balanced with an acceptable quality of life is the primary aim in treating patients with metastatic breast cancer. Patients and Methods: 224 patients from 11 centers were randomized to treatment with 40 mg/m2 of Adriamycin or with 40 mg/m2 of epirubicin or with 12 mg/m2 of mitoxantrone each in combination with 600 mg/m2 of cyclophosphamide every 3 weeks. A special monitoring system including follow-up until death guaranteed valid information on response criteria, survival and quality of life. Results: Treatment outcome was not statistically different between the three groups in terms of best response rate, response duration, time to progression or survival. There were, however, statistically significant differences between the three treatment groups in terms of toxicity and quality of life. Most important, treatment outcome was influenced by the following negative prognostic factors: disease-free interval less than 18 months; metastases at more than one organ site; performance status according to WHO > 1; prior adjuvant chemotherapy; age less than 40 years. Conclusions: This meticulously monitored prospectively randomized study shows that prognostic factors are more important than the chosen treatments for the outcome in metastatic breast cancer patients.

Prognostic factors for patients with liver metastases from breast cancer

“…Median survival time after the occurrence of liver metastases is reported from 1 to 20 months [2,4,5,[8][9][10].…”

First-Line Monochemotherapy with Mitoxantroneversus Combination with Fluorouracil, Epirubicin and Cyclophosphamide in High-Risk Metastatic Breast Cancer: A Prospective Randomized Multicenter Clinical Trial

“…It was believed that concomitant toxicity was 'worthwhile' in order to get a higher rate of CR which would result in longer median survival time. In an earlier performed prospective randomized study we had compared 3 combinations which differed moderately in their aggressiveness [1]. It has been shown that prognostic criteria were more important than the choice of treatment.…”

“…In the entire population, neither remission rates nor median survival time differed significantly between the 2 groups receiving either mild monochemotherapy or aggressive combination chemotherapy. While subgroups eventually drawing benefit from combination treatment are being evaluated, we must state that quality of life and gain from treatment as measured in a modified Brunner's score [1,3] [18] showed a better CR rate with FEC 75 than with FEC 50 (p = 0.025) or with epirubicin (p = 0.002), but mean duration of response, TTP, and survival time were not different between the three groups. Only during the first 8 months, survival time seemed to be better in the FEC 75 group compared with the FEC 50 group.…”

“…1) [1]. 260 patients fulfilling high-risk criteria were randomized to receive either 12 mg/m 2 mitoxantrone (N) or 500 mg/m 2 fluorouracil plus 50 mg/m 2 epirubicin plus 500 mg/m 2 cyclophosphamide (FEC) every 3 weeks until complete remission (CR) plus 2 cycles or for 12 cycles (partial remission (PR) or no change (NC)) or until tumor progression.…”

Deutsche Krebsgesellschaft e.V.

“…[1984][1985][1986][1987][1988] hatte gezeigt, daß bei der Auswertung wichtige prognostische Faktoren zu berücksichtigen sind, da diese die Überlebenszeit deutlich beeinflussen [2]. Das Besondere an dieser größten prospektiv-randomisierten Datensammlung (n = 891, einschließlich von Low-risk-Fällen) für metastasiertes Mammakarzinom in Deutschland ist, daß einmal -im Gegensatz zu vielen anderen Studien -die Patientinnen so lange nachbeobachtet werden, daß solide Ergebnisse für den Überlebenszeitvergleich vorliegen, zum anderen aber auch von Anfang an Lebensqualitätserhebungen durchgeführt wurden.…”