Defining the Survival Benchmark for Breast Cancer Patients with Systemic Relapse

Zeichner, Simon B.; Ambros, Tadeu; Zaravinos, John; Montero, Alberto J.; Mahtani, Reshma; Ahn, Eugene; Mani, Aruna; Markward, Nathan; Vogel, Charles L.

doi:10.4137/bcbcr.s23794

Cited by 15 publications

(18 citation statements)

References 29 publications

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“…We repeated this analysis for the eight studies (28–32,35,37,49,50) that collected data on unadjusted survival after recurrence separately for ER-positive (3073 patients) and ER-negative disease (1239 patients) (Table 2, Figure 3, B and C). Although numbers were smaller than for recurrent disease as a whole, we observed similar trends in survival improvement over time in ER-positive and ER-negative recurrent disease: from 1980 to 1990, the median survival ratio was 1.08 (95% CI = 0.66 to 1.79; P = 0.75) for ER-positive disease and 0.95 (95% CI = 0.55 to 1.66; P = 0.87) for ER-negative disease; from 1990 to 2000, the median survival ratio was 1.25 (95% CI = 1.05 to 1.49; P = .014) for ER-positive disease and 1.30 (95% CI = 1.08 to 1.57; P = .007) for ER-negative disease; and from 2000 to 2010, the median survival ratio was 1.44 (95% CI = 0.93 to 2.21; P = .10) for ER-positive disease and 1.77 (95% CI = 1.13 to 2.79; P = .01) for ER-negative disease.…”

Section: Resultsmentioning

confidence: 99%

“…First, only three of the studies we analyzed reported data on HER2 status, so we cannot determine how much the success of HER2-targeted therapies may have contributed to our findings for ER-positive and ER-negative breast cancer. However, because HER2-positive cancers were the minority in studies that reported HER2 (<30%) (28,50,61), they are unlikely to account for all of the observed survival improvement, suggesting that improvement has been made in triple-negative disease as well. Similarly, only one-quarter of the patients analyzed for recurrent disease had ER status available, decreasing the precision of estimates by ER status.…”

Section: Discussionmentioning

confidence: 99%

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Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review

Caswell-Jin

Plevritis

Tian

et al. 2018

JNCI Cancer Spectrum

230

167

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BackgroundMetastatic breast cancer (MBC) treatment has changed substantially over time, but we do not know whether survival post-metastasis has improved at the population level.MethodsWe searched for studies of MBC patients that reported survival after metastasis in at least two time periods between 1970 and the present. We used meta-regression models to test for survival improvement over time in four disease groups: recurrent, recurrent estrogen (ER)-positive, recurrent ER-negative, and de novo stage IV. We performed sensitivity analyses based on bias in some studies that could lead earlier cohorts to include more aggressive cancers.ResultsThere were 15 studies of recurrent MBC (N = 18 678 patients; 3073 ER-positive and 1239 ER-negative); meta-regression showed no survival improvement among patients recurring between 1980 and 1990, but median survival increased from 21 (95% confidence interval [CI] = 18 to 25) months to 38 (95% CI = 31 to 47) months from 1990 to 2010. For ER-positive MBC patients, median survival increased during 1990–2010 from 32 (95% CI = 23 to 43) to 57 (95% CI = 37 to 87) months, and for ER-negative MBC patients from 14 (95% CI = 11 to 19) to 33 (95% CI = 21 to 51) months. Among eight studies (N = 35 831) of de novo stage IV MBC, median survival increased during 1990–2010 from 20 (95% CI = 16 to 24) to 31 (95% CI = 24 to 39) months. Results did not change in sensitivity analyses.ConclusionBy bridging studies over time, we demonstrated improvements in survival for recurrent and de novo stage IV MBC overall and across ER-defined subtypes since 1990. These results can inform patient-doctor discussions about MBC prognosis and therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review

Caswell-Jin

Plevritis

Tian

et al. 2018

JNCI Cancer Spectrum

230

167

View full text Add to dashboard Cite

show abstract

“…Depending on the tumour mass and tumour biology, breast cancer patients have highly varied prognoses 1 , 2 . In about 15% of breast cancers, there is neither expression of the estrogen (ER) and progesterone receptor (PgR) (≤ 1%) nor an overexpression or amplification of the human epidermal growth factor receptor (HER) 2 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Brustkrebspatientinnen haben in Abhängigkeit von Tumormasse und Tumorbiologie eine sehr unterschiedliche Prognose 1 , 2 . Bei etwa 15% der Mammakarzinome liegen weder eine Expression des Östrogen-(ER-) und Progesteronrezeptors (PgR) (≤ 1%) noch eine Überexpression bzw.…”

Section: Introductionunclassified

Diagnosis and Therapy of Triple-Negative Breast Cancer (TNBC) – Recommendations for Daily Routine Practice

Schneeweiß

Denkert

Fasching

et al. 2019

Geburtshilfe Frauenheilkd

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The rapid increase in knowledge in tumour biology and tumour pathogenesis of triple-negative breast cancer (TNBC) has resulted in new therapeutic approaches and new therapeutic concepts for treatment. For years, TNBC has been considered to be a difficult-to-treat tumour due to its generally aggressive tumour biology and in view of limited therapeutic options. The risk of recurrence and metastasis is higher than in the case of other breast cancer subtypes of the same stage. In addition to surgery and radiation in the curative situation, systemic chemotherapy with anthracyclines and/or taxanes is still the therapy of choice. New therapeutic approaches are based on the knowledge that TNBC is a molecularly very heterogeneous disease. Research groups are working to classify TNBC better and better on a molecular level and use this molecular subtyping as the basis for new therapeutic strategies. The most promising new approaches and considerations regarding the therapy of TNBCs are shown below. In addition, the current therapeutic strategies are discussed using a fictitious case history, taking the current data and the resultant therapeutic consequence into account.

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“…The 5-year overall survival rates among patients with axillary, supraclavicular, and internal mammary lymph node (IMN) recurrences are limited to 24% to 35% 1, 2. IMN involvement has been reported to comprise only 1% of patients with locoregional failures 4, 5. Advances in radiographic imaging, however, suggest that IMN failures may have been underdetected because FDG (fludeoxyglucose)–positron emission tomography and magnetic resonance imaging improve the detection of IMN metastases not identified on conventional chest imaging 6, 7…”

Section: Introductionmentioning

confidence: 99%

Overall Survival of Breast Cancer Patients With Locoregional Failures Involving Internal Mammary Nodes

DeSelm

et al. 2019

Advances in Radiation Oncology

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Purpose Internal mammary node recurrence after definitive breast cancer treatment is poorly characterized, with limited data to guide clinical management. The aim of this study was to analyze the outcomes of patients with recurrent breast cancer involving internal mammary nodes to understand their natural history and determine prognostic factors associated with improved overall survival. Methods and Materials We performed a retrospective analysis of 553 patients with recurrent breast cancer and identified 161 patients with radiographic evidence of locoregional recurrence as a first event. A total of 67 patients (42%) were identified with internal mammary involvement. Median follow-up times were 76 months from date of initial diagnosis and 30 months from date of recurrence. Results Of the 67 patients identified with internal mammary node failures, 10 (15%) presented with isolated recurrence, 14 (21%) presented with other sites of locoregional disease, and 43 (64%) presented with concomitant distant metastases. Median overall survival was 2.5 years and significantly associated with extent of disease ( P < .0001). On multivariable analysis, concomitant distant metastases, inflammatory breast cancer, and triple negative histologic type were associated with worse overall survival, whereas salvage radiation therapy was associated with improved overall survival. Among the 10 patients with isolated internal mammary node failures, median progression-free survival was 6.0 years and salvage therapy with surgery, radiation, and chemotherapy were associated with the best outcomes. Conclusions Patients with isolated internal mammary node recurrences achieved long-term survival with aggressive therapies, and salvage radiation therapy was associated with improved survival.

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Defining the Survival Benchmark for Breast Cancer Patients with Systemic Relapse

Cited by 15 publications

References 29 publications

Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review

Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review

Diagnosis and Therapy of Triple-Negative Breast Cancer (TNBC) – Recommendations for Daily Routine Practice

Overall Survival of Breast Cancer Patients With Locoregional Failures Involving Internal Mammary Nodes

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