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

Abstract

The purpose of the present study was to analyze the clinical and pathological characteristics, treatment, and prognosis of de novo metastatic breast cancer (DnMBC). Information regarding 1,890 patients treated for advanced breast cancer at the Tianjin Medical University Cancer Hospital between January 2008 to December 2017 was collected. Clinicopathological characteristics, treatments and outcomes of these patients were compared using the chi-square test, log-rank test, and Cox regression analysis. A total of 171 patients were diagnosed with DnMBC. The median age at diagnosis was 53 years (range, 23-77). The percentage of T4 staging was higher (37.4%), 69.6% of patients were estrogen receptor (ER) positive, 59.1% were progesterone receptor positive, 29.8% had positive human epidermal growth factor receptor 2 (HER2) status, 68.4% had Ki-67 ≥20%, 55% had oligometastasis at the initial diagnosis, ~87.7% were treated with chemotherapy initially and 24% received palliative surgery for the primary tumor. After a median follow-up time of 26 months, the median progression-free survival (PFS) and overall survival (OS) among patients with DnMBC were 11 (8.7-13.3) months and 34 (27.9-40.1) months, respectively. In the multivariable model, ER status and sites of first metastasis (oligometastasis or polymetastasis) were identified to be independent predictors of PFS (P<0.05); ER status, primary tumor stage, and surgical treatment of primary tumors were identified to be independent predictors of OS (P<0.05). In conclusion, the clinicopathological characteristics of DnMBC are greater invasiveness and a higher risk of progression. Palliative surgical treatment may improve the prognosis of HR+/HER2-patients with oligometastasis. Therefore, individualized treatment as required is particularly important.

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

“…37 In addition, multicentric or large, single institution series have been reported from MD Anderson Cancer Center 38 and academic institutions from the USA, 3,39 Netherlands, 40 Japan 41 and China. 42 Of note, the definition of dnMBC slightly varied amongst series, including tumours with metastases discovered at the same time or within 3-6 months from breast cancer diagnosis. HR + /HER2is by far the most frequent subtype amongst dnMBC, reaching 60% of cases in most series, despite conflicting data on incidence, as compared with rMBC, whilst HER2 + tumours, which mostly occur at a higher incidence in the de novo cohort and TN tumours, are definitely less frequently represented amongst dnMBC.…”

“…2 In subsequent studies reporting outcomes for the HR + / HER2subtype (Table 1), mOS ranged from 26 months to nearly 5 years in patients with particularly favourable prognostic features, such as young age and bone-only disease, but was generally lower than that of HR + /HER2 + dnMBC, 5,18,19,24,25,34,38,46 though this difference was not statistically different in all series and even favours the former subtype in some small series. 28,29,42 Patients with HR + /HER2 + tumours maintained an improved OS even if the proportion of patients with bone-only disease, a known favourable prognostic factor, was generally much higher in patients with HR + /HER2tumours. 18,19,39 Breast cancer specific survival was also reported to be higher in patients with HR + /HER2 + breast cancer (from 44 months to 72 months) than in those with HR + /HER2 - tumours (50 and 20 months; in moderate and poorly differentiated tumours, respectively).…”

SnapshotDx Quiz: November 2020

“…The acquisition of de novo mutations in metastatic tumors: Although it is true that de novo mutations lead to heterogeneity in melanoma, this statement does not explain the authors' findings, which indicate that primary tumors may be composed of genetically distinct subclones capable of metastatic spread, even in the absence of exogenous therapeutic pressure. It is worth noting that de novo mutations in metastatic tumors are not the same as de novo metastatic tumors, which refers to tumors that are diagnosed as metastatic from the start (Zhang et al, 2020).…”

Developments in the Management of Metastatic HER2-Positive Breast Cancer: A Review

“…Breast cancer remains the most commonly diagnosed cancer in Canadian women, representing 25% of all malignancies diagnosed in women in 2020 [1]. An estimated 15-20% are found to over-express human epidermal growth factor receptor 2 (HER2) [2], and despite advances in treatment, approximately 15-24% will develop metastatic disease after completion of curative-intent treatment, and 3-10% present with de novo metastatic disease [3,4]. The development of trastuzumab, the first HER2-directed monoclonal antibody, greatly improved the prognosis and outcomes of patients with HER2-positive breast cancer, but management remains challenging in the post-trastuzumab era [5].…”