[Lani]

from ASCO GI IN SAN FRANCISCO--Wish the study was for her2+ vs her2-, but rather it was for er+ vs er-

THE NEGATIVE:Resection of breast cancer liver metastases in patients with chemotherapy-responsive, estrogen receptor (ER)-positive primary tumors was associated with increased survival compared with resection of tumors in ER-negative primary tumors.

An ER-negative tumor and preoperative disease progression despite chemotherapy were associated with a three- to fourfold worse survival after liver metastasis resection.


THE POSITIVE:

SAN FRANCISCO -- Resection of breast cancer liver metastases paid off in a survival benefit in patients with chemotherapy-responsive, estrogen receptor (ER)-positive primary tumors, according to data from a retrospective chart review.
The chart review of more than 80 patients found those with ER-positive tumors had a median survival of 77 months with liver resection compared with 23 months for ER-negative tumors (P<0.001). An objective response to chemotherapy was associated with a median survival of 79 months versus 32 months for progressive disease as best response (P=0.049), researchers reported here at the Gastrointestinal Cancers Symposium.

In a multivariate analysis, an ER-negative tumor and preoperative disease progression were associated with a three- to fourfold worse survival after liver metastasis resection.

Although the cases were small in number, they are relevant in the context of changing views about cancer that metastasizes to the liver, said Daniel E. Abbott, MD, of the University of Texas MD Anderson Cancer Center in Houston.

"I think there has been a paradigm shift over the past 10 years or so, where it has been realized that resection of metastases from a lot of different histologic types can lead to long-term survival," Abbott told MedPage Today. "I don't think that was recognized previously. As other centers have had experience with long-term survivors, it has become more accepted."

"I think there has been something of a nihilistic attitude toward breast cancer metastasis to other organs in the past," he added.

Generally incurable, most liver metastases from breast cancer are treated with chemotherapy or hormonal therapy. However, oncologists increasingly have recognized that a subset of patients derives a substantial benefit from hepatic resection, said Abbott.

The characteristics of long-term survivors with liver metastases have remained unclear. In an effort to identify some of these traits, Abbott and colleagues reviewed medical records of breast cancer patients and found 86 patients who underwent resection of liver metastases from 1997 to 2010.

Three fourths (64 of 86) of the patients had estrogen- or progesterone receptor-positive tumors, 53 (62%) had solitary liver metastases, and 73 (85%) had liver metastases <5 cm. In addition, 65 (76%) of the patients received preoperative chemotherapy, and 10 (12%) patients received two or more chemotherapy regimens prior to resection of their liver metastases.

Defining best response as the optimal response at any time during metastatic disease, the investigators found that only two patients had progression as best response, but 19 (29%) patients had preoperative progression.

After a median follow-up of 62 months median overall and progression-free survival (PFS) were 57 and 14 months, respectively.

Univariate analysis revealed several predictors of improved or worse survival, including:

Preoperative response to chemotherapy, 79 versus 29 months, P=0.018
Preoperative progression, 23 versus 79 months, P≤0.001
Hormone receptor-negative (ER/PR-) primary tumor, 28 versus 77 months, P≤0.001
Similarly, several factors predicted PFS, including:

Objective response, 31 versus 6.4 months, P≤0.001
Stable disease, 25.3 versus 7.5 months, P=0.037
Preoperative progression, 6.4 versus 26.3 months, P<0.001
Post-hepatectomy chemotherapy, 20.7 versus 12.2 months, P=0.008
Multivariate analysis showed that an ER-negative primary tumor was associated with survival hazard of 3.3 (P=0.009) and preoperative disease progression with a hazard of 3.8 (P=0.003).

Although the review identified only a small number of cases over a 13-year period, the researchers said the findings were relevant in light of recent changes in clinical concepts about breast cancer liver metastases.

And, the findings could prove useful to physicians in discussions with patients about the possible benefits of liver resection.

"I think this information is most valuable when people are willing to counsel patients and make the tougher decisions about who should and should not have surgery and then let patients make informed decisions," said Abbott.

"If patients have a poor prognosis, they need to understand that perhaps they should not be undergoing such an invasive procedure. Conversely, people need to understand that some patients can have very long survival. Even though it's not very common, there are a select few patients with favorable biology who can benefit greatly form surgery," he added.