Adjuvant Therapy Reduces the Benefit of Palliative Treatment in Disseminated Breast Cancer - Own Findings and Review of the Literature

Abstract

Background: Adjuvant treatment concepts have improved the 10-year cure rate of breast and colon cancer, but new treatments for metastatic disease have yielded only incremental benefit. If treatments for disseminated cancer were actually prolonging life rather than only increasing remission rates, this effect should have been documented over the last 30+ years. However, published data concerning advances in treatment for disseminated cancer have been contradictory. Patients and Methods: To add data-based information, we analyzed 2 sources: a regional population-based cancer registry (Hamburgisches Krebsregister, HKR), and a research cancer registry (Projektgruppe Internistische Onkologie, PIO). We compared the survival of several thousand patients with metastatic disease who received treatment only after dissemination with that of patients who received initial adjuvant therapy. Results: After adjuvant treatment, survival in patients with disseminated breast cancer is up to a third shorter than that of patients without adjuvant therapy. Conclusions: In accordance with published evidence, we conclude that ineffective adjuvant treatment shortens survival after documentation of metastatic disease. This is probably due to the elimination of chemo-sensitive tumor cells or to the induction of resistance in remaining micrometatases. This negative effect on survival after dissemination has been shown clearly for breast cancer and is also probable for cancer of the colon and other sites.

Adjuvant Therapy-Related Shortening of Survival (ATRESS): An Underrated Phenomenon

“…In our study, in agreement with the findings of Seidman et al [1], overall survival after dissemination was shortened by onethird when patients received adjuvant taxanes compared with a non-taxane-containing adjuvant therapy [2].…”

Adjuvant Therapy Reduces Rate of Dissemination but Shortens Survival Thereafter

“…Finally, we would like to encourage Xu et al [1] to believe their own findings because after adjuvant taxane treatment, they described a reduction of survival time after dissemination by one-third [3], which is identical with our results [6].…”

“…This is not the case, and we absolutely agree that adjuvant treatment increases the cure rate, but in the subgroup of patients who suffer from metastases despite adjuvant therapy, survival after dissemination is shortened. This is partially due to an adjuvant chemotherapy-induced resistance to previous treatment and may be similar after hormonal therapy and immunotherapy [6].…”

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

“…The administration of these drugs to treat primary breast cancer has been suggested to decrease overall survival from the time of diagnosis of metastatic disease by one-third [31e33,35e37,39]. We have found a similar one-third reduction in post-metastatic survival when comparing P1 to P4 [35,37]. Of note, in the first cohort, taxanes and anthracyclines were not clinically available for adjuvant treatment of primary breast Fig.…”