Litle Improvement after Thirty Years

Smaller Larger

Litle Improvement after Thirty Years

Posted 10/17/2012

Posted in

I really dislike being the bearer of bad tidings, but this article from "Cancer" is important. Especially during Pink October, we are all brainwashed/pinkwashed with positive statements and the overall impression that breast cancer is almost a thing of the past. How I wish that were true! It certainly is true that many/most women who are appropriately treated at the time of diagnosis do fine. It is also true that many women are initially diagnosed with Stage IV breast cancer. In my group this week for women with advanced breast cancer, this was an important topic since more than half of the participants are in this situation. That is, they were going along with their lives, taking reasonable or very good care of themselves, having annual mammograms and other recommended health care...and then, Bang: a diagnosis of Stage IV breast cancer.

The "good" news (and I am using that term rather cynically because obviously there is nothing good about this) for them is that their bodies are innocent of chemotherapy, so they likely will have good responses to many drugs. Those of us who are initially treated with adjuvant chemotherapy and then go on to someday develop metastatic breast cancer are the subject of this study.

There indeed are many new effective treatments and a lot of hope about future targeted treatments. What we do need to remember, however, is that breast cancer can be a deadly disease, and we must keep the pressure on funders (meaning mostly the US Government) to continue to support research. Are you aware that our politically deadlocked Congress has allowed something called "sequestering" to automatically bring big cuts to all federal spending in early 2013? Unless they can get their act together and vote otherwise, all federal budgets will be slashed, including cancer research. Think about it.

Survival in Patients With Metastatic Recurrent Breast Cancer After Adjuvant Chemotherapy

Little Evidence of Improvement Over the Past 30 Years

Amye J. Tevaarwerk, MD1; Robert J. Gray, PhD2; Bryan P. Schneider, MD3; Mary Lou Smith, JD, MBA4; Lynne I.Wagner, PhD5; John H. Fetting, MD6; Nancy Davidson, MD7; Lori J. Goldstein, MD8; Kathy D. Miller, MD3; and Joseph A. Sparano, MD9

BACKGROUND: Population-based studies have shown improved survival for patients diagnosed with metastatic breast cancer over time, presumably because of the availability of new and more effective therapies. The objective of the current study was to determine whether survival improved for patients who developed distant recurrence of breast cancer after receiving adjuvant therapy.

METHODS: Adjuvant chemotherapy trials coordinated by the Eastern Cooperative Oncology Group that accrued patients between 1978 and 2002 were reviewed.

Survival after distant disease recurrence was estimated for progressive time periods, and adjusted for baseline covariates in a Cox proportional hazards model.

RESULTS: Of the 13,785 patients who received adjuvant chemotherapy in 11 trials, 3447 (25%) developed distant disease recurrence; the median survival after recurrence was 20 months (95% confidence interval, 19 months-21 months). Factors associated with inferior survival included a shorter distant recurrence-free interval (DRFI), estrogen receptor-negative and progesterone receptor-negative disease, the number of positive axillary lymph nodes present at the time of diagnosis, and black race (P <.0001 for all). When the time period of recurrence was added to the model, it was not found to be significantly associated with survival for the general population with disease recurrence. Survival improved over time only in those patients with hormone receptor-negative disease with a DRFI ! 3 years, both among the 5 most recent and the entire trial data sets (P ¼.01 and P ¼.05, respectively).

CONCLUSIONS: In contrast to reports from population-
based studies, no general improvement in survival was observed over the last 30 years for patients who developed distant disease recurrence after adjuvant chemotherapy after adjusting for DRFI. Improved survival for patients with hormone receptor-negative disease with a short DRFI suggests a benefit from trastuzumab. Cancer 2012;000:000-000. VC 2012 American Cancer Society.