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Early surgery for stage IV breast cancer failed to improve OS
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SAN ANTONIO — Initial surgery of the primary tumor was not associated with longer survival in women with stage IV breast cancer, according to early results of study presented at the San Antonio Breast Cancer Symposium.
However, patients with bone-only metastases and solitary bone metastases, as well as those who were younger than 55 years, tended to demonstrate improved OS.
Atilla Soran
“There have been many retrospective studies on initial surgery for stage IV breast cancer presentation,” Atilla Soran, MD, MPH, of the Magee-Women’s Hospital at the University of Pittsburgh Medical Center, said during a presentation. “Most of the studies actually are in favor for the initial surgery to the primary tumor. But multiple groups of analysis have shown conflicting results.”
Soran and colleagues evaluated data from 278 patients. Of them, 140 received initial locus therapy plus systemic therapy, and 138 received systemic therapy alone.
Baseline characteristics were similar between treatment arms. Most patients had grade 2 (40% for the surgery group and 32.4% for the systemic therapy group) or grade 3 (55.7% vs. 58.1%) histology. Researchers said 86.4% of patients in the surgery arm and 72.3% in the systemic treatment arm had ER/PR-positive disease; 30.7% of patients in the surgery arm and 30.4% in the systemic treatment arm were HER-2–positive.
All patients received chemotherapy. Patients with ER/PR-positive breast cancer received hormone therapy, and patients with HER-2–positive disease received trastuzumab (Herceptin, Genentech).
Median follow-up in this early analysis was 18 months (range, 1-55) in the surgery arm and 17 months (range, 1-54) in the systemic treatment arm.
Overall, 38 deaths occurred in the surgical treatment arm and 48 deaths occurred in the systemic treatment arm.
Median OS was 46 months in the surgery group and 42 months in the systemic treatment group.
Researchers calculated a 0.76 HR (95% CI, 0.49-1.16) for death in the surgical group, which was not statistically different from the risk associated with systemic treatment.
Patients with ER/PR-positive tumors had improved outcomes in the surgical treatment arm, but the difference was not statistically significant (HR=0.77; 95% CI, 0.45-1.31).
Patients with ER/PR-negative tumors treated with surgery did not fare as well as patients who were ER/PR-positive, but the difference with systemically treated patients remained statistically insignificant (HR=1.47; 95% CI, 0.70-3.12).
Researchers observed improved survival in patients with bone-only metastases (HR=0.6; 95% CI, 0.3-1.22) and solitary bone metastases (HR=0.23; 95% CI, 0.06-0.89).
Surgical treatment was associated with improved survival in patients younger than 55 years (HR=0.62; 95% CI, 0.34-1.14).
Initial surgery worsened outcomes in patients with multiple liver or pulmonary metastases (HR=3.85; 95% CI, 1.12-13.25).
“There was no statistically different difference in OS at this early follow-up, and longer follow-up is necessary,” Soran said. “When we reach the final data at 3 years, we will give all the information, but as of now the data is not mature enough yet to make conclusions in this subset of patients.”
For more information:
Soran A. Abstract #S2-03. Presented at: San Antonio Breast Cancer Symposium; Dec. 10-14, 2013; San Antonio.
Disclosure: The researchers report no relevant financial disclosures.