The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy

Mudgway, Ross; Villanueva, Carlos Chavez de Paz; Lin, Ann; Senthil, Maheswari; Garberoglio, Carlos A.; Lum, Sharon S.

doi:10.1245/s10434-020-08310-2

Cited by 20 publications

(20 citation statements)

References 44 publications

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“…Neuman et al reported that surgery in conjunction with systemic therapy, compared with systemic therapy alone, resulted in a trend toward an increased OS with a significant improvement in OS in women with ER/PR positivity or HER2 positivity ( p = 0.004), but no benefit of surgery was observed in triple‐negative breast cancer 4 . Similar to our study, Mudgway et al showed that median survival of patients who underwent surgery was 25 months versus 18 months for patients who did not undergo surgery ( p < 0.0001) and OS was significantly improved in women who underwent surgery with systemic therapy 8 …”

Section: Characteristics All Patients N (%) Breast Surgery N (%) No Surgery N (%) P Valuesupporting

confidence: 87%

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Retrospective study of clinical outcomes in patients with Stage IV HER2+ breast cancer undergoing primary breast surgery

et al. 2021

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Section: Characteristics All Patients N (%) Breast Surgery N (%) No Surgery N (%) P Valuesupporting

confidence: 87%

“…4 Similar to our study, Mudgway et al showed that median survival of patients who underwent surgery was 25 months versus 18 months for patients who did not undergo surgery (p < 0.0001) and OS was significantly improved in women who underwent surgery with systemic therapy. 8 Our study provides additional evidence that removal of primary…”

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confidence: 52%

Retrospective study of clinical outcomes in patients with Stage IV HER2+ breast cancer undergoing primary breast surgery

et al. 2021

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“…203 Another possible mechanism is a so-called abscopal effect beyond the irradiated volume, influencing the distribution and growth of distant tumour deposits. 204 Although several retrospective analyses [205][206][207] suggested that local or locoregional surgery, radiotherapy, or both, improve overall survival, two prospective randomised trials did not show a consistent and clear benefit with surgery, which might at least in part be attributed to methodological and regional issues. 208,209 However, a multicentre retrospective cohort including 4507 patients with primary metastatic breast cancer showed that radiotherapy with or without surgery, but not surgery alone, improved overall survival after adjustment for known prognostic factors and propensity score analysis.…”

Section: Non-systemic Options For Metastatic Breast Cancer Including Local Therapiesmentioning

confidence: 99%

Breast cancer

et al. 2021

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Breast cancer is still the most common cancer worldwide. But the way breast cancer is viewed has changed drastically since its molecular hallmarks were extensively characterised, now including immunohistochemical markers (eg, ER, PR, HER2 [ERBB2], and proliferation marker protein Ki-67 [MKI67]), genomic markers (eg, BRCA1, BRCA2, and PIK3CA), and immunomarkers (eg, tumour-infiltrating lymphocytes and PD-L1). New biomarker combinations are the basis for increasingly complex diagnostic algorithms. Neoadjuvant combination therapy, often including targeted agents, is a standard of care (especially in HER2-positive and triple-negative breast cancer), and the basis for de-escalation of surgery in the breast and axilla and for risk-adapted post-neoadjuvant strategies. Radiotherapy remains an important cornerstone of breast cancer therapy, but de-escalation schemes have become the standard of care. ER-positive tumours are treated with 5-10 years of endocrine therapy and chemotherapy, based on an individual risk assessment. For metastatic breast cancer, standard therapy options include targeted approaches such as CDK4 and CDK6 inhibitors, PI3K inhibitors, PARP inhibitors, and anti-PD-L1 immunotherapy, depending on tumour type and molecular profile. This range of treatment options reflects the complexity of breast cancer therapy today.

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“…LRT can consist of surgery alone, RT alone, or both. Several retrospective series have reported an association between LRT and improved survival in patients with stage IV breast cancer at the time of diagnosis [ 9 , 10 , 11 , 12 , 13 , 14 ]. A meta-analysis including 28,693 patients found that surgical excision of the primary breast lesion improved the three-year survival from 22% to 40% ( p < 0.01) [ 15 ].…”

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confidence: 99%

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Kim

et al. 2020

Cancers

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Purpose: Locoregional treatment has been increasingly adopted for metastatic breast cancer at presentation. This study aims to develop an individualized calculator to predict the benefit of postoperative radiotherapy (PORT) for patients with surgically resected de novo stage IV breast cancer. Methods and Materials: We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with stage IV breast cancer between 2010 and 2014. After applying exclusion criteria, a total of 4473 patients were included in the analysis. Propensity score matching was used to balance the individual characteristics of the patients. After identifying the significant prognosticators, a nomogram was developed using multivariate regression models and internally validated. A web-based calculator was then constructed using a fitted survival prediction model. Results: With a median follow-up of 34 months, the three-year overall survival (OS) rates were 54.1% in the surgery alone group and 63.5% in the surgery + PORT group (p < 0.001). The survival benefit of PORT was maintained after propensity score matching (p < 0.001). Interaction testing of the prognostic variables found significant interactions between PORT and the presence of brain metastasis (p = 0.001), and between PORT and hormonal receptor expression (p = 0.018). After reviewing the performance of various models, a log-normal distributed survival model was adopted, with a C-index of 0.695. A calibration plot verified that the predicted survival rates were strongly correlated with the actual OS rates. A web-based survival calculator was constructed to provide individualized estimates of survival according to PORT. Conclusion: PORT significantly improved OS rates, though the individual benefit was affected by a number of factors. We successfully developed a nomogram and web-based calculator that predicted the prognosis according to PORT in patients with surgically resected de novo stage IV breast cancer. These tools are expected to be useful in clinical practice and in the design of related trials.

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The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy

Cited by 20 publications

References 44 publications

Retrospective study of clinical outcomes in patients with Stage IV HER2+ breast cancer undergoing primary breast surgery

Retrospective study of clinical outcomes in patients with Stage IV HER2+ breast cancer undergoing primary breast surgery

Breast cancer

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

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