improved survival for those with only liver mets

[Lani]

when discussing metastatic bc, most oncologists repeat the dogma that the patient will probably be dead in two years no matter what you do and it doesn't seem to matter if you find mets early, the result will be the same.
Whereas on its surface this study may not sound very encouraging, the trend definitely is and if this study had been performed with targetted agents, cryoablation, or other new modalities, the results might have been better.

The potentially good news:

Now that they are examining oligometastatic disease (that with one or few mets) and subdividing them by location of mets (eg bone only vs liver only)
they are finding prognoses are/need not have to be as pessimistic as they had been maintaining. I hope with subclassification by tumor type and by continued treatment with targeted therapies this trend will continue and there will be a realization that biomarkers (eg, her2ecd etc) and prophylactic brain mris for those most at risk may end up improving the lot of those with Stage 4

off the soapbox--here is the abstract

Cancer J. 2008 January/February;14(1):62-68.
Clinical Course of Breast Cancer Patients With Metastases Limited to the Liver Treated With Chemotherapy.

Er O, Frye DK, Kau SW, Broglio K, Valero V, Hortobagyi GN, Arun B.
From the *Erciyes University Medical Faculty, Department of Medical Oncology, Kayseri, Turkey; â€*Department of Breast Medical Oncology, M. D. Anderson Cancer Center, Houston, TX; and ‡Department of Biostatistics, M. D. Anderson Cancer Center, Houston, TX.
PURPOSE:: The purpose of this retrospective analysis was to describe the clinical course of patients with breast cancer with liver metastases alone who were treated on doxorubicin/cyclophosphamide or taxane-containing chemotherapy protocols at the M. D. Anderson Cancer Center. PATIENTS AND METHODS:: A total of 2,193 patients with metastatic breast cancer were treated on prospective clinical protocols at the University of Texas M. D. Anderson Cancer between 1973 and 2003. Among those, 132 were identified as having the liver as the first site of metastatic disease. The following information was obtained from the medical records: gender, age, race, performance status, menopausal status, hormonal receptor status, laboratory data, primary treatment, prior systemic treatment, disease-free interval, extent of metastatic disease, response to chemotherapy, site of progression, time to tumor progression, overall survival, and cause of death. RESULTS:: Of the patients 62% received anthracycline-based regimens and 38% received anthracycline- and taxane-based regimens on various clinical protocols as the initial therapy for metastatic disease. The median follow-up of the patients was 52 months. The overall objective response rate was 66.4%; 16.4% of the patients achieved complete responses. The median time to progression was 14 months. Progression-free survival rates were 56% and 30% at 12 and 24 months, respectively. The median overall survival was 25 months. Sixteen patients (12.1%) survived longer than 60 months. There was a statistically inverse relation between a high lactate dehydrogenase level and achieving a complete response (P < 0.05). Age >/=50 years, extent of liver metastases, performance status, and lactate dehydrogenase and albumin levels are significantly related to progression-free survival (P < 0.05). Year of liver metastases diagnosis, extent of liver metastases, performance status, and albumin level are significantly related to overall survival (P < 0.05). CONCLUSIONS:: This retrospective analysis demonstrated that patients with liver metastases only had high objective response rates and encouraging results for median survival obtained with currently available cytotoxic agents.
PMID: 18303485 [PubMed - as supplied by publisher]