Article

Significant survival improvement of patients with recurrent breast cancer in the periods 2001-2008 vs. 1992-2000

Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan.
BMC Cancer (Impact Factor: 3.32). 03/2011; 11:118. DOI: 10.1186/1471-2407-11-118
Source: PubMed

ABSTRACT It is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer. The purpose of this study is to evaluate the survival improvement of patients with recurrent breast cancer after the introduction of third generation aromatase inhibitors (AIs) and trastuzumab.
A total of 407 patients who received first diagnosis of recurrent breast cancer and treatment at National Kyushu Cancer Center between 1992 and 2008 were retrospectively evaluated. As AIs and trastuzumab were approved for clinical use in Japan in 2001, the patients were divided into two time cohorts depending on whether the cancer recurred before or after 2001. Cohort A: 170 patients who were diagnosed between 1992 and 2000. Cohort B: 237 patients who were diagnosed between 2001 and 2008. Tumor characteristics, treatments, and outcome were compared.
Fourteen percent of cohort A and 76% of cohort B received AIs and/or trastuzumab (P < 0.001). The median overall survival (OS) times after breast cancer recurrence were 1.7 years and 4.2 years for these respective cohorts (P < 0.001). Both the time period and treatment of AIs and/or trastuzumab for recurrent disease were significant prognostic factors in multivariate analysis (cohort B vs. cohort A: HR = 0.70, P = 0.01; AIs and/or trastuzumab for recurrent disease: yes vs. no: HR = 0.46, P < 0.001). When patients were categorized into 4 subgroups by the expression of hormone receptor (HR) and HER-2 status, the median OS times of the HR-positive/HER-2-negative, HR-positive/HER-2-positive, HR-negative/HER-2-positive, and HR-negative/HER-2-negative subtypes were 2.2, 2.4, 1.6, and 1.0 years in cohort A and 4.5, 5.1, 5.0, and 1.4 years in cohort B.
The prognosis of patients with recurrent breast cancer was improved over time following the introduction of AIs and trastuzumab and the survival improvement was apparent in HR- and/or HER-2-positive tumors.

Download full-text

Full-text

Available from: Kenichi Taguchi, Jun 30, 2015
0 Followers
 · 
111 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unlike early stage breast cancer, metastatic breast cancer (MBC) is generally considered incurable except for a small number of patients with oligometastatic disease. The goal of treatment of MBC should be the prolongation of life and improvement of symptoms and quality of life. The prognoses of patients with MBC, however, have been improved with the introduction of newer, more effective agents. Therefore, the clinical question arises whether MBC patients can be cured with these new therapeutic agents. However, there are a couple of problems in tackling this question, including the duration of follow-up and the presence of strong adjuvant therapy. Firstly, most trials in MBC have a relatively short follow-up; long-term surveillance (>3-5 years) is exceptional, so little is known about the definitive outcome and the exact proportion of long-term survivors. Secondly, most of the patients have received pre- or postoperative adjuvant therapy. The cancer cells at metastatic sites are considered to be relatively resistant to the agents used in metastatic settings. Promisingly, a number of novel therapeutic agents including antibody-drug conjugates, irreversible small molecule HER2-tyrosine inhibitors, and HER2 dimerization inhibitors show promise in the treatment of HER2-overexpressing MBC, as well as PARP-1 [poly(ADP-ribose) polymerase-1] inhibitors for triple-negative breast cancer.
    Breast Cancer 06/2011; 19(3):212-7. DOI:10.1007/s12282-011-0277-2 · 1.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We report a case of HER-2-positive recurrent breast cancer showing a clinically complete response to trastuzumab-containing chemotherapy 6 years after primary treatment of triple-negative breast cancer. The primary tumor was negative for HER-2 as determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) (1+, and ratio, 1.1), but examination of the recurrent lymph node metastasis showed positivity for HER-2 by FISH (ratio, 5.2). No lesions were detected in either her left breast or in other organs, and the patient was diagnosed as having HER-2-positive recurrent disease. Combination chemotherapy using weekly paclitaxel and trastuzumab was initiated, and a clinically complete response was achieved. This report suggests the benefit of routine evaluation of HER-2 status in recurrent breast cancer with the introduction of HER-2-targeting agents.
    World Journal of Surgical Oncology 11/2011; 9:146. DOI:10.1186/1477-7819-9-146 · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The triple-negative breast cancer (TNBC) phenotype, defined as the lack of estrogen and progesterone hormone receptors and the HER2 receptor, represents approximately 15% to 20% of all breast cancer cases. Challenges faced in management of these patients arise from the heterogeneity of TNBC and the absence of well-defined molecular targets. Subgroups derive significant benefit from cytotoxics however, patients with TNBC have higher rates of distant recurrence and a poorer prognosis than women with other breast cancer subtypes overall. Currently, cytotoxic chemotherapy is the only systemic treatment option at all stages of disease, and rational drug selection based on tumor biology remains an aspiration. In the context of relapse, the most efficacious regimens remain undefined and the typical clinical picture is one of rapid disease progression and little durable benefit to therapy. This article reviews current approaches in metastatic TNBC and considers novel therapies in development that may improve the outlook for those with this disease.