Impact of modern chemotherapy on the survival of women presenting with de novo metastatic breast cancer

BMC Cancer

Sumanta K Pal³  Mary Dehaven³  Rebecca A Nelson²  Susan Onami³  JoAnn Hsu³  Sarah Waliany³  Laura Kruper¹  Joanne Mortimer³ 

[1] Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

[2] Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

[3] Division of Genitourinary Malignancies, Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

关键词: Stage IV;    Metastatic breast cancer;    Survival;    Endocrine therapy;    Chemotherapy;   

Others  :  1080174
DOI  :  10.1186/1471-2407-12-435

 received in 2012-03-09, accepted in 2012-09-26,  发布年份 2012

【 摘 要 】

Background

Data that directly associate utilization of novel systemic therapies with survival trends in metastatic breast cancer (MBC) are limited. In the setting of de novo MBC, large registry analyses cite positive temporal trends in survival, but the extent to which advances in systemic therapy have contributed to these gains is not clear.

Methods

The City of Hope Cancer Registry was used to identify a consecutive series of patients with de novo MBC who received their first line of therapy between 1985 and 2004. Comprehensive clinicopathologic and treatment-related data were collected for each patient. Univariate analyses were conducted via Cox regression to identify factors associated with improved survival. Multivariate analysis was also conducted via Cox regression and the stepwise procedure was used to identify independent predictors of survival.

Results

A total of 324 patients with de novo MBC were identified. After application of exclusion criteria, including the sole presence of supraclavicular node metastasis, 274 patients were retained in the analysis. The treatment-related characteristics associated with improved survival included: use of endocrine therapy (hazard ratio [HR] 0.60, 95%CI 0.47-0.77; P<0.0001), and addition of bisphosphonates (HR 0.70, 95%CI 0.52-0.96; P=0.02). However, recipients of novel cytotoxic agents (defined as drugs approved for MBC since 1994) had no improvement in survival relative to patients treated with older cytotoxic agents. On multivariate analysis, age (< 50), receipt of aromatase inhibitors, and receipt of zoledronic acid were independent predictors of survival.

Conclusions

The overall survival of women with de novo metastatic breast cancer has improved over the past 20 years. However, the contribution of conventional cytotoxic agents to this improvement is minimal.

【 授权许可】

   
2012 Pal et al.; licensee BioMed Central Ltd.

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