Survival in patients with metastatic recurrent breast cancer after adjuvant chemotherapy

Abstract

Purpose Population-based studies have shown improved survival for patients diagnosed with metastatic breast cancer (MBC) over time, presumably due to the availability of new and more effective therapies. The objective of this analysis was to determine if survival improved for patients who developed distant recurrence of breast cancer after receiving adjuvant therapy. Methods Adjuvant chemotherapy trials coordinated by the Eastern Cooperative Oncology Group (ECOG) that accrued patients between 1978–2002 were reviewed. Survival following distant recurrence was estimated for progressive time periods, and adjusted for baseline covariates in a Cox proportional hazards model. Results Of the 13,785 patients who received adjuvant chemotherapy in 11 trials, 3447 (24.4%) developed distant recurrence; median survival following recurrence was 20 months (95% confidence intervals: 19, 21). Factors associated with inferior survival included shorter distant recurrence free interval (DRFI), ER- and PR-negative disease number of positive axillary nodes at diagnosis and black race (p<0.0001 for all). When time-period of recurrence was added to the model, it was not significantly associated with survival for the general population with recurrence. Survival improved over time only in hormone-receptor negative patients with a DRFI ≤ 3 years, both among the 5 recent and entire trial datasets (p=0.01 and p=0.05 respectively). Conclusions In contrast to reports from population-based studies, we did not observe general improvement in survival over the last three decades for patients who developed distant recurrence after adjuvant chemotherapy after adjusting for DRFI. Improved survival for hormone-receptor negative patients with a short DRFI suggests benefit from trastuzumab.

Factors Associated with Breast Cancer Mortality after Local Recurrence

“…Despite progress made in the adjuvant treatment of breast cancer since 1992, it is not clear if the life expectancy of women who experience a local recurrence has subsequently increased 1,4 , and it will be important to follow our cohort and others for updated analyses. Similarly, it has been reported that little improvement has been observed since the early 1980s in the survival of women with distant metastases 16 . It has previously been reported that the survival experience after local recurrence is relatively poor if the recurrence occurs early 2-4 .…”

De NovoPost-Diagnosis Aspirin Use and Mortality in Women with Stage I–III Breast Cancer

“…There are no data to indicate what the appropriate lag time should be for post-diagnostic exposures in analyses of breast cancer-specific mortality. The exposure lag was, therefore, set at 2 years, the median survival time after a breast cancer recurrence (21) and varied in sensitivity analyses (0, 1, 3, and 4 years).…”

NRF2 immunolocalization in human breast cancer patients as a prognostic factor

“…and chemotherapy after surgical treatment, distant recurrence in the patients treated with tamoxifen after surgery has been reported 15% at 10 years (Paik et al 2004) and 25% of the patients who received adjuvant chemotherapy developed distant recurrence (Tevaarwerk et al 2013). Therefore, it is very important to evaluate clinical and biological markers in breast cancer patients to predict its recurrence after surgery and to evaluate indications for additional therapies appropriately.…”