Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcome of Turkish Metastatic Breast Cancer Patients with Currently Available Treatment Modalities - Single Center Experience

  • Cabuk, Devrim (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Basaran, Gul (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Teomete, Mehmet (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Dane, Faysal (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Korkmaz, Taner (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Seber, Selcuk (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Telli, Ferhat (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Yumuk, Perran Fulden (Department of Medical Oncology, Faculty of Medical School, Marmara University) ;
  • Turhal, Serdar (Department of Medical Oncology, Faculty of Medical School, Marmara University)
  • Published : 2014.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Breast cancer is the most common malignancy and the second leading cause of cancer-related death among women in the developed countries. Despite advances in screening, improved local therapies and adjuvant systemic treatments, median survival of metastatic breast cancer patients (MBC) is in the range of 2-3 years at most. We aimed to investigate whether the prognostic factors and therapeutic responses of our Turkish patients are similar to those in the literature. Materials and Methods: We reviewed the medical records of MBC patients who had been treated in our institution between 1999-2009 and analyzed their clinicopathological features and survival outcomes retrospectively Results: A hundred and sixty patients were included. Median age was 47 (23-82), median follow up was 24 (2-186) months. At the time of diagnosis 59% of patients were under the age of 50 and 46% were postmenopausal. The majority (37%) had multiple sites of metastases. Forty percent received endocrine therapy and 40% chemotherapy as first line metastatic treatment. Thirty (20%) patients were treated with molecular targeting agents like trastuzumab, lapatinib and sunitinib, frequently combined with a chemotherapy agent. Five-year overall survival (OS) was 32% and median OS was 38 months for the whole group. Five year progression free survival (PFS) was 10% and median PFS was 10 months. Menopausal status, hormone receptor expression and disease free status had a significant impact on overall survival in the multivariate analysis (p 0.018, p 0.018 and p:0.003, respectively). Conclusions: All our patients were treated with the modern oncologic therapies recommended by the international guidelines. From our data, MBC patients live up to 3-4 years, indicating that further improvement beyond that requires development of new treatment modalities. The survival outcomes of our patients were consistent with the data reported in the literature.

Keywords

References

  1. Aaltomaa S, Lipponen P, Eskelinen M, et al (1992). Prediction of outcome after first recurrence of breast cancer. Eur J Surg, 158, 13.
  2. Alba E, Martin M, Ramos M, et al (2004). Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first-line treatment of metastatic breast cancer: a Spanish Breast Cancer Research Group (GEICAM-9903) phase III study. J Clin Oncol, 22, 2587. https://doi.org/10.1200/JCO.2004.08.125
  3. Baselga J, Campone M, Piccart M, et al (2012). Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med, 366, 520. https://doi.org/10.1056/NEJMoa1109653
  4. Beslija S, Bonneterre J, Burstein HJ, et al (2009). Third consensus on medical treatment of metastatic breast cancer. Ann Oncol, 20, 1771-85 https://doi.org/10.1093/annonc/mdp261
  5. Bonneterre J, Thurlimann B, Robertson JF, et al (2000). Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability study. J Clin Oncol, 18, 3748-57.
  6. Breen N, Croni, K, Meissner HI, et al (2007). Reported drop in mammography: is this cause for concern? Cancer, 109, 2405. https://doi.org/10.1002/cncr.22723
  7. Brewster AM, Hortobagyi GN, Broglio KR, et al (2008). Residual risk of breast cancer recurrence 5 years after adjuvant therapy. J Natl Cancer Inst, 100, 1179-83. https://doi.org/10.1093/jnci/djn233
  8. Burstein HJ, Keshaviah A, Baron AD, et al (2007). Trastuzumab plus vinorelbine or taxane chemotherapy for HER2-overexpressing metastatic breast cancer: the trastuzumab and vinorelbine or taxane study. Cancer, 110, 965-72. https://doi.org/10.1002/cncr.22885
  9. Buzdar A, Jonat W, Howell A, et al (1996). Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal women with advanced breast cancer: Results of overview analysis of two phase III trials. J Clin Oncol, 14, 2000.
  10. Cameron D, Casey M, Press M, et al (2008). A phase III randomized comparison of lapatinib plus capecitabine versus capecitabine alone in women with advanced breast cancer that has progressed on trastuzumab: updated efficacy and biomarker analysis. Breast Cancer Res Treat, 112, 533. https://doi.org/10.1007/s10549-007-9885-0
  11. Carrick S, Parker S, Thornton CE, et al (2009). Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev, 2, 3372.
  12. Chia SK, Speers CH, D'yachkova Y, et al (2007). The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer, 110, 973. https://doi.org/10.1002/cncr.22867
  13. Chlebowski RT, Kuller LH, Prentice RL, et al (2009). Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med, 360, 573. https://doi.org/10.1056/NEJMoa0807684
  14. Conte PF, Guarneri V, Bruzzi P, et al (2004). Concomitant versus sequential administration of epirubicin and paclitaxel as first-line therapy in metastatic breast carcinoma: results for the Gruppo Oncologico Nord Ovest randomized trial. Cancer, 101, 704. https://doi.org/10.1002/cncr.20400
  15. Dombernowsky P, Smith I, Falkson G, et al (1998). Letrozole, a new oral aromatase inhibitor for advanced breast cancer: Double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate. J Clin Oncol, 16, 453.
  16. Gancberg D, Di Leo A, Cardoso F, et al (2002). Comparison of HER-2 status between primary breast cancer and corresponding distant metastatic sites. Ann Oncol, 13:1036. https://doi.org/10.1093/annonc/mdf252
  17. Gennari A, Conte P, Rosso R, Orlandini C, Bruzzi P (2005). Survival of metastatic breast carcinoma patients over a 20-year period: a retrospective analysis based on individual patient data from six consecutive studies. Cancer, 104, 1742. https://doi.org/10.1002/cncr.21359
  18. Glass AG, Lacey JV Jr, Carreon JD, Hoover RN (2007). Breast cancer incidence, 19802006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst, 99, 1152. https://doi.org/10.1093/jnci/djm059
  19. Gong Y, Booser DJ, Sneige N (2005). Comparison of HER-2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma. Cancer, 103, 1763. https://doi.org/10.1002/cncr.20987
  20. Kuukasjarvi T, Kononen J, Helin H, Holli K, Isola J (1996). Loss of estrogen receptor in recurrent breast cancer is associated with poor response to endocrine therapy. J Clin Oncol, 14, 2584.
  21. Macfarlane R, Seal M, Speers C, et al (2012). Molecular alterations between the primary breast cancer and the subsequent locoregional/metastatic tumor. Oncologist, 17, 172-8. https://doi.org/10.1634/theoncologist.2011-0127
  22. Martin M, Ruiz A, Munoz M, et al (2007). Gemcitabine plus vinorelbine versus vinorelbine monotherapy in patients with metastatic breast cancer previously treated with anthracyclines and taxanes: final results of the phase III Spanish Breast Cancer Research Group (GEICAM) trial. Lancet Oncol, 8, 219. https://doi.org/10.1016/S1470-2045(07)70041-4
  23. Milla-Santos A, Milla L, Portella J, et al (2003). Anastrozole versus tamoxifen as first-line therapy in postmenopausal patients with hormone-dependent advanced breast cancer: a prospective, randomized, phase III study. Am J Clin Oncol, 26, 317-22.
  24. Mouridsen H, Gershanovich M, Sun Y, et al (2003). Phase III study of letrozole versus tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: analysis of survival and update of efficacy from the International Letrozole Breast Cancer Group. J Clin Oncol, 21, 2101-9. https://doi.org/10.1200/JCO.2003.04.194
  25. Nabholtz JM, Buzdar A, Pollak M, et al (2000). Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group. J Clin Oncol, 18, 3758-67.
  26. Nicolini A, Giardino R, Carpi A, et al (2006). Metastatic breast cancer: an updating. Biomed Pharmacother, 60, 548-56. https://doi.org/10.1016/j.biopha.2006.07.086
  27. Norris B, Pritchard KI, James K, et al (2000). Phase III comparative study of vinorelbine combined with doxorubicin versus doxorubicin alone in disseminated metastatic/ recurrent breast cancer: national cancer institute of canada clinical trials group study MA8. J Clin Oncol, 18, 2385.
  28. O'Shaughnessy J, Miles D, Vukelja S, et al (2002). Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results. J Clin Oncol, 20, 2812. https://doi.org/10.1200/JCO.2002.09.002
  29. Osoba D (1995). Health-related quality of life as a treatment endpoint in metastatic breast cancer. Can J Oncol, 5, 47.
  30. Paridaens RJ, Dirix LY, Beex LV, et al (2008). Phase III study comparing exemestane with tamoxifen as first-line hormonal treatment of metastatic breast cancer in postmenopausal women: the european organisation for research and treatment of cancer breast cancer cooperative group. J Clin Oncol, 26, 4883-90. https://doi.org/10.1200/JCO.2007.14.4659
  31. Robbins AS, Clarke CA (2007). Regional changes in hormone therapy use and breast cancer incidence in California from 2001 to 2004. J Clin Oncol, 25, 3437. https://doi.org/10.1200/JCO.2007.11.4132
  32. Robert N, Leyland-Jones B, Asmar L, et al (2006). Randomized phase III study of trastuzumab, paclitaxel, and carboplatin compared with trastuzumab and paclitaxel in women with HER-2-overexpressing metastatic breast cancer. J Clin Oncol, 24, 2786-92. https://doi.org/10.1200/JCO.2005.04.1764
  33. Robertson JF, Howell A, Buzdar A, von Euler M, Lee D (1999). Static disease on anastrozole provides similar benefit as objective response in patients with advanced breast cancer. Breast Cancer Res Treat, 58, 157. https://doi.org/10.1023/A:1006391902868
  34. Ravdin PM, Cronin, KA, Howlader N, et al (2007). The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med, 356, 1670. https://doi.org/10.1056/NEJMsr070105
  35. Rusnak DW, Lackey K, Affleck K, et al (2001). The effects of the novel, reversible epidermal growth factor receptor/ ErbB-2 tyrosine kinase inhibitor, GW2016, on the growth of human normal and tumor-derived cell lines in vitro and in vivo. Mol Cancer Ther, 1, 85-94.
  36. Saphner T, Tormey DC, Gray R (1996). Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol, 14, 2738-46.
  37. Slamon DJ, Leyland-Jones B, Shak S, et al (2001). Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med, 344, 783. https://doi.org/10.1056/NEJM200103153441101
  38. Sledge GW, Neuberg D, Bernardo P, et al (2003). Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J Clin Oncol, 21, 588. https://doi.org/10.1200/JCO.2003.08.013
  39. Smigal C, Jemal A, Ward E, et al (2006). Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin, 56, 168-83. https://doi.org/10.3322/canjclin.56.3.168
  40. Soto C, Torrecillas L, Reyes S (2006). Capecitabine (X) and taxanes in patients with anthracycline-pretreated metastatic breast cancer: sequential vs. combined therapy results from a MOSG randomized phase III trial (abstract). J Clin Oncol, 24, 20. https://doi.org/10.1200/JCO.2006.05.9964
  41. Stadtmauer EA, O'Neill A, Goldstein LJ, et al (2000). Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group. N Engl J Med, 342, 1069. https://doi.org/10.1056/NEJM200004133421501
  42. Swain S (2008). Triple-negative breast cancer: metastatic risk and role of platinum agents. 2008 Asco Clinical Science Symposium.
  43. Trivers KF, Lund MJ, Porter PL, et al (2009). The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control, 20, 1071. https://doi.org/10.1007/s10552-009-9331-1
  44. Valero V, Forbes J, Pegram MD, et al (2011). Multicenter phase III randomized trial comparing docetaxel and trastuzumab with docetaxel, carboplatin, and trastuzumab as first-line chemotherapy for patients with HER2-gene-amplified metastatic breast cancer (BCIRG 007 study): two highly active therapeutic regimens. J Clin Oncol, 29, 149-56. https://doi.org/10.1200/JCO.2010.28.6450
  45. Xia W, Mullin RJ, Keith BR, et al (2002). Anti-tumor activity of GW572016: A dual tyrosine kinase inhibitor blocks EGF activation of EGFR/erbB2 and downstream Erk1/2 and AKT pathways. Oncogene, 21, 6255-63. https://doi.org/10.1038/sj.onc.1205794
  46. Zidan J, Dashkovsky I, Stayerman C, et al (2005). Comparison of HER-2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease. Br J Cancer, 93, 552. https://doi.org/10.1038/sj.bjc.6602738

Cited by

  1. Systemic Analysis on Risk Factors for Breast Cancer Related Lymphedema vol.15, pp.16, 2014, https://doi.org/10.7314/APJCP.2014.15.16.6535
  2. Investigation of Antitumor Effects of Sorafenib and Lapatinib Alone and in Combination on MCF-7 Breast Cancer Cells vol.15, pp.7, 2014, https://doi.org/10.7314/APJCP.2014.15.7.3185
  3. Trastuzumab-based Retreatment after Lapatinib in Heavily Pretreated HER2 Positive Metastatic Breast Cancer: an Anatolian Society of Medical Oncology Study vol.16, pp.9, 2015, https://doi.org/10.7314/APJCP.2015.16.9.4127