ASCO 2013--Stage IVs living longer and longer as treatments improve

[Lani]

Abstract only from upcoming asco--her2 not mentioned, probably because data based on SEER results which probably don't record her2 status


Is the proportion of patients with synchronous stage IV breast cancer surviving > 2 years increasing over time?

Sub-category:
ER+

Category:
Breast Cancer - HER2/ER

Meeting:
2013 ASCO Annual Meeting

Abstract No:
524

Citation:
J Clin Oncol 31, 2013 (suppl; abstr 524)

Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Shaheenah S. Dawood, Benjamin Haaland, Constance T. Albarracin, Ana M. Gonzalez-Angulo, Sudeep Gupta, Javier Cortes, Yoon Sim Yap, Rebecca Dent; Dubai Hospital, Dubai, United Arab Emirates; Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; Tata Memorial Centre, Mumbai, India; Vall d'Hebron University Hospital, Barcelona, Spain; National Cancer Centre Singapore, Singapore, Singapore; National Cancer Center Singapore, Duke-National University Singapore, Singapore, Singapore

Abstract Disclosures


Abstract:

Background: Studies have shown a moderate increase in survival over time among pts with stageIV breast cancer. Median survival is approximately 2 yrs. The aim of this study was to evaluate trends over time of pts with synchronous stage IV disease who survive >2 yrs. Methods: Using the SEER registry we identified female pts with synchronous stage IV breast cancer diagnosed between 1990-2007. Pts were divided into 3 groups according to year of diagnosis(1990-1995, 1996-2000, 2001-2007). Probability of surviving more than >2 yrs was computed within each group. A multivariable logistic regression model was then fitted to determine the association between year of diagnosis and the probability of surviving >2 yrs after adjusting for other prognostic factors. Results: 22,492 pts were identified of whom 9,388 (41.7%) had a survival of >2 yrs. The probability of surviving >2 yrs was 36.2%, 40.1%, and 44.2% among pts diagnosed in periods 1990-1995, 1996-2000, and 2001-2007 respectively (p-value < 0.0001). The probability of surviving >2 yrs was 55.3% and 29.3% among pts with ER+ and ER- disease respectively (p-value <0.0001) and was 32.9% and 43.5% among pts of black and white race respectively (p-value <0.0001). In the multivariable model the probability of surviving >2 yrs increased with increasing year of diagnosis (OR 1.04, 95% CI 1.03-1.05, p <0.0001). Other factors significantly associated with an increased probability of surviving >2 yrs included radiation therapy, lower grade, younger age, hormone receptor (HR) positive disease and non-inflammatory disease. Interaction term between race and year of diagnosis was marginally significant, such that black pts had a more slowly increasing probability of surviving >2 yrs compared to whites (OR 0.97, 95% CI 0.96-1.00, p = 0.037). Interaction term between HR status and year of diagnosis was not significant. Conclusions: Our results indicate that among pts with synchronous stage IV breast cancer the probability of surviving >2 yrs has increased over time reflecting the introduction and FDA approval of multiple efficacious chemotherapeutic and endocrine therapeutic options. Of concern, the probability of surviving >2 yrs has increased more slowly among pts of black race.

[Pray]

Any increase in life span is a good increase! In cancer land a win for some of us is a wi for all of us.

[Bunty]

Thanks Lani - does synchronous stage IV breast cancer mean that a patient is stage iv at initial diagnosis?
Cheers Marie

['lizbeth]

I would infer synchronous with stage IV from initial diagnosis from reading this:

http://annonc.oxfordjournals.org/con...nc.mdq301.full

Data from the Surveillance, Epidemiology, and End Results (SEER) program and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project indicate that ∼6% of women newly diagnosed with breast cancer have stage IV disease, representing ∼12 600 new cases per year in the United States in 2005 [1, 2]. The 5-year overall survival (OS) rate among such patients rarely exceeds 20% [3]. Survival can be improved by endocrine therapy, chemotherapy, and biological therapy [4, 5]. Local treatment is often recommended to prevent or relieve symptoms but is traditionally considered to have no noteworthy impact on survival [4, 5]. However, several recent observational studies have shown that 35%–60% of breast cancer patients with stage IV disease at diagnosis receive treatment of the primary tumor and that this treatment is associated with a survival advantage [6–18]. The impact of treatments targeting regional lymphatics is unclear, and the patient subgroups most likely to benefit from treatment of the primary tumor remain to be identified. Two prospective studies are currently examining the benefits of locoregional therapy compared with systemic therapy alone in this setting. The main objective of this review is to highlight current issues regarding treatment of the primary tumor in breast cancer patients with synchronous metastases in order to highlight clinicians in their therapeutic decision.

[Lani]

Citation:
J Clin Oncol 31, 2013 (suppl; abstr e12003)
Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual
Meeting but not presented at the Meeting, can be found online only.
Author(s): Pengyu Chen, Skye H Hong-Chun Cheng; Koo Foundation Sun Yat-Sen Cancer Center, Taipei
City, Taiwan
Abstract Disclosures
Abstract:
Background: Breast cancer has three major subtypes, including luminal-like (hormone receptor positive, no
HER2 overexpression), HER2-rich (HER2 overexpression), and triple negative (hormone receptor negative
and no HER2 overexpression). This study is to analyze the prognosis in each subtype of stage IV breast
cancer patients. Methods: We reviewed 246 patients with de novo stage IV breast cancer treated at our
hospital between 1990 and 2009. Multivariable Cox analysis was used to determine the survival associated
the subtypes and clinicopathologic factors. Results: Patients with luminal-like subtype are mostly
premonopausal (66.9%, P=0.0002), with abnormal CA 15-3 level at initial diagnosis (58.7%, P=0.01), with
higher rate of bone mets (78.1%, P=0.02), and less rate of liver mets (23.1%, P<0.0001). Patients with HER2-
rich and triple negative had higher rate of nuclear grade III of primary breast tumor, up to 35% and 40%,
respectively (P=0.01). There is no difference in the systemic chemotherapy (82.2~95%, P=0.09) and
locoregional treatment (40.0~51.2%, P=0.23) among three groups. The median overall survival of 246
patients was 23.1 months. The median overall survival in patients with luminal-like, HER2-rich, and triple
negative subtype were 39.6, 17.9, and 13.3 months, respectively (P<0.0001). In multivariate analysis,
hormone receptor and HER2 status were significant independent factors associated with survival (P<0.0001).
Other significant factors associated with survival included liver mets (Hazard Ratio 2.3, P<0.0001), lung mets
(Hazard Ratio 1.7, P=0.0004), and brain mets (Hazard Ratio 1.5, P=0.03). In subgroup analysis, locoregional
treatment to primary breast tumor had significant survival benefit in patients with luminal-like (P=0.0001)
and HER2-rich(P=0.0012) subtype. In triple negative subtype, local treatment did not improve outcome
(P=0.9575). Conclusions: Hormone receptors and HER2 status are the most important factors affecting
survival for these patients. Locoregional treatment to primary breast tumor may provide better outcome,
especially those with luminal-like or HER2-rich subtype.

[Lani]

ALong those lines they have just shown that her2+s benefit more than others from removal of the primary tumor

Citation:
J Clin Oncol 31, 2013 (suppl; abstr e12003)
Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual
Meeting but not presented at the Meeting, can be found online only.
Author(s): Pengyu Chen, Skye H Hong-Chun Cheng; Koo Foundation Sun Yat-Sen Cancer Center, Taipei
City, Taiwan
Abstract Disclosures
Abstract:
Background: Breast cancer has three major subtypes, including luminal-like (hormone receptor positive, no
HER2 overexpression), HER2-rich (HER2 overexpression), and triple negative (hormone receptor negative
and no HER2 overexpression). This study is to analyze the prognosis in each subtype of stage IV breast
cancer patients. Methods: We reviewed 246 patients with de novo stage IV breast cancer treated at our
hospital between 1990 and 2009. Multivariable Cox analysis was used to determine the survival associated
the subtypes and clinicopathologic factors. Results: Patients with luminal-like subtype are mostly
premonopausal (66.9%, P=0.0002), with abnormal CA 15-3 level at initial diagnosis (58.7%, P=0.01), with
higher rate of bone mets (78.1%, P=0.02), and less rate of liver mets (23.1%, P<0.0001). Patients with HER2-
rich and triple negative had higher rate of nuclear grade III of primary breast tumor, up to 35% and 40%,
respectively (P=0.01). There is no difference in the systemic chemotherapy (82.2~95%, P=0.09) and
locoregional treatment (40.0~51.2%, P=0.23) among three groups. The median overall survival of 246
patients was 23.1 months. The median overall survival in patients with luminal-like, HER2-rich, and triple
negative subtype were 39.6, 17.9, and 13.3 months, respectively (P<0.0001). In multivariate analysis,
hormone receptor and HER2 status were significant independent factors associated with survival (P<0.0001).
Other significant factors associated with survival included liver mets (Hazard Ratio 2.3, P<0.0001), lung mets
(Hazard Ratio 1.7, P=0.0004), and brain mets (Hazard Ratio 1.5, P=0.03). In subgroup analysis, locoregional
treatment to primary breast tumor had significant survival benefit in patients with luminal-like (P=0.0001)
and HER2-rich(P=0.0012) subtype. In triple negative subtype, local treatment did not improve outcome
(P=0.9575). Conclusions: Hormone receptors and HER2 status are the most important factors affecting
survival for these patients. Locoregional treatment to primary breast tumor may provide better outcome,
especially those with luminal-like or HER2-rich subtype.
Other