Twenty-years experience withde novometastatic breast cancer

Abstract

Although new treatments have been widely studied to improve the survival of patients with metastatic breast cancer (BC), prognosis continues to be poor with an average survival time no longer than 3 years. We carried on a population-based study with the purpose of evaluating the outcome of metastatic breast cancer in the province of Modena from 1990 to 2009. We examined the Modena Cancer Registry and evaluated the 5-year overall survival (OS) of women diagnosed with a de novo metastatic breast cancer between 1990 and 2009, defining 5 periods of 4 years each. After a median followup time of 29 months, the 5-year OS was 11% for years 1990-1993, 15% for years 1994-1997, 12% for years 1998-2001, 20% for years 2002-2005 and 29% for years 2006-2009 (p 5 0.012). Overall, although no OS differences were noted in the first decade analyzed, a real advantage has been shown in the last two cohorts. In a multivariate analysis, the 5-year OS was significantly increased only for hormone receptor positive and HER21 tumors, whereas chemotherapy treatments were not significant independent predictors of survival in "de novo" metastatic BC (p 5 0.08). Our analysis confirms that the prognosis of de novo metastatic breast cancer has improved overtime, particularly in the last decade. Trastuzumab, LH-RH analogues and aromatase inhibitors have determined a significant clinical benefit and costeffectiveness in metastatic breast cancer treatment.Breast cancer (BC) continues to be the most common form of cancer that affects women, but currently is no longer the leading cause of cancer deaths. However, the prognosis of patients with metastatic disease continues to be poor, with an average survival time no longer than 3 years.1,2 Although clinical trials suggest that early detection strategies and advances in adjuvant therapy are improving outcomes, it is unclear if this may affect patterns of relapse and 20-30% of patients with early BC will eventually develop relapse with distant metastatic disease. Therefore, distant recurrence remains common and incurable and, currently, the principal goal of treatment for women with metastatic disease is to improve quality of life and to prolong survival. 3,4 Although new treatments have been widely investigated in the metastatic setting, it is not clear whether the overall outcome has improved. Particularly, Seruga et al.5 observed no significant change in outcome or in absolute benefit of experimental therapies in Phase III randomized clinical trials evaluating treatment for metastatic BC. Moreover, the costs of experimental medical therapies approved for metastatic disease increase [mt]100-fold each month, without any gain in the absolute benefit. Therefore, Seruga et al.5 demonstrated that new and expensive treatments of metastatic BC lead to unchanging levels of benefit and rapidly increasing costs, concluding that new therapies are becoming much less costeffective. Moreover, Galy et al.6 performed a retrospective study to examine temporal trends in the use of chemotherapeutic agents for the treat...

De�novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

“…Nearly 90% of the patients in this study received initial chemotherapy and >90% of the patients chose taxanes or anthracyclines as the first-line chemotherapy, of whom 58.5% were treated with the combination of the two drugs. It can be seen that the proportion of chemotherapy is compared with the study by Cortesi et al (6) and there are relatively few studies on the treatment. Considering the differences in traditional concepts among people in different regions, the Chinese are pursuing active and comprehensive treatment, while the Western population is pursuing a higher quality of life, which may have led to the above-mentioned differences in treatment.…”

“…The proportion of multiple metastasis and visceral metastasis was relatively high, and more patients had high expression of Ki-67 and high histological grade (6). Although some progress has been made in the treatment of MBC in the past decade, according to real-world and clinical trial data, the 5-year survival is still low at ~25% (6)(7)(8)(9). The purpose of this retrospective study was to analyze the clinicopathological characteristics of DnMBC and to explore the prognostic factors, in order to provide guidance for clinical diagnosis and treatment.…”

“…Prior reports state that the clinicopathological features of DnMBC were greater invasiveness. The proportion of multiple metastasis and visceral metastasis was relatively high, and more patients had high expression of Ki-67 and high histological grade (6). Although some progress has been made in the treatment of MBC in the past decade, according to real-world and clinical trial data, the 5-year survival is still low at ~25% (6)(7)(8)(9).…”

Invasive Breast Cancer Over Four Decades Reveals Persisting Poor Metastatic Outcomes In Treatment Resistant Subgroup – The “ATRESS” Phenomenon

“…Other studies [17,20,34,37,45,46] have described changes in the clinical pattern of breast cancer and metastatic breast cancer over a short-to-medium term, though none have reported such a large cohort of breast cancer patients, including systemic treatment details, from a single centre over an extensive period of 40 years.…”

Optimizing Quality of Life in Patients with Hormone Receptor-Positive Metastatic Breast Cancer: Treatment Options and Considerations

“…Death rates from breast cancer (BC) have declined since 1989 [1] , and among more than 3 million survivors of BC in the United States (US), more than 155,000 patients are living with MBC [2] . Indeed, data demonstrate statistically and clinically meaningful improvements in outcome measures such as progression-free survival (PFS) and overall survival within some MBC patient subpopulations, including de novo MBC, hormone receptor-positive (HR-positive), and human epidermal growth factor receptor 2-positive (HER2-positive) disease [3][4][5] . A key management goal and consideration when selecting treatment for patients with MBC is to maintain quality of life (QoL).…”