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Possible clinical cure of metastatic breast cancer: lessons from our 30-year experience with oligometastatic breast cancer patients and literature review

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  • From improved survival to potential cure in patients with metastatic breast cancer
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Abstract

Background

Metastatic breast cancer (MBC) is generally incurable. However, 10–20-year relapse-free survival of MBC is approximately 2%, implying that at least a small subset of MBC patients achieve prolonged survival. We therefore analyzed long-term outcome in a particular subset, i.e., oligometastatic breast cancer (OMBC).

Methods

Data of OMBC subjects (N = 75) treated in our institution from April 1980 to March 2010 were retrospectively analyzed. OMBC was identified as: one or 2 organs involved with metastatic lesions (excluding the primary lesion resectable by surgery), fewer than 5 lesions per metastasized organ, and lesion diameter less than 5 cm. Patients were generally treated with systemic chemotherapy first, and those who achieved complete response (CR) or partial response (PR) were further treated, if applicable, with local therapy (surgical or radiation therapy) to maintain CR or to induce no evidence of clinical disease (NED), with additional systemic therapy.

Results

Median follow-up duration was 103 (6–329) months. Single or 2 organs were involved in, respectively, 44 (59%) and 31 (41%) cases with metastatic lesions, 48% of which were visceral. In cases where effects of systemic therapy, possibly in combination with other treatments, were evaluated (N = 68), CR or PR was achieved in 33 (48.5%) or 32 (47.1%), respectively, with overall response rate (ORR: CR + PR) of 95.6% (N = 65). In cases receiving multidisciplinary treatment (N = 75), CR or NED (CR/NED), or PR was induced in 48 (64.0%) or 23 (30.7%) cases, respectively, with ORR (CR/NED + PR) of 94.7% (N = 71). CR rates (60.5%) with systemic therapy and CR/NED rates (79.5%) with multidisciplinary treatment were significantly better in subjects with a single involved organ than in those with two involved organs (P = 0.047 and 0.002, systemic only or multidisciplinary treatments, respectively).

Medians estimated by Kaplan–Meier method were: overall survival (OS) of 185.0 months and relapse-free interval (RFI) of 48.0 months. Estimated outcomes were: OS rates (OSR) of 59.2% at 10 years and 34.1% at 20 years, and relapse-free rates (RFR) of 27.4% at 10 years and 20 years. No disease progression was observed after 101.0 months as RFR. Cases with single organ involvement (N = 44) showed significantly better outcomes (OSR of 73% at 10 years and 52% at 20 years, RFR of 42% at 10 years and 20 years). Those who received local therapies (N = 35) also showed better prognosis: OSR of 82% at 10 years and 53% at 20 years, RFR of 38% at 10 years and 20 years. Three cases (4%) survived for their lifetime without relapse after achieving CR or NED, our definition of clinical cure.

Multivariate analysis revealed factors favoring better prognosis as: none for OS, and single organ involvement with metastasis, administration of local treatment, and shorter disease-free interval (DFI) (P = 0.030, 0.039, and 0.042, respectively) for RFR. Outcomes in OMBC in literature were OSR of 35–73% at 10 years and 26–52% at 20 years, and RFR of 27–42% at 10 years and 26–42% at 20 years.

Conclusions

The present analyses clearly indicate that OMBC is a distinct subgroup with long-term prognosis superior to MBC, with reasonable provability for clinical cure. Further prospective studies to better characterize OMBC are warranted to improve prognosis in MBC.

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Acknowledgments

First and foremost, we acknowledge the courage and vision of the patients who participated in our clinical studies that enabled us to reach our present understanding of breast cancer biology. We would also like to thank all the physicians, nurses, pharmacists, and other staff members of the participating hospitals and universities for their genuine and continual efforts to support our study. We appreciate the considerable support provided by Ms. Akiko Akahori in her administrative work and data collection in preparing the current manuscript, and Mss. Michiko Kasai and Kana Tamura for their pathological expertise. The lead author is most grateful for 30 years’ mentoring and assistance for a long-lasting journey in breast cancer clinical practice and studies in medical oncology by Dr. Makoto Ogawa, President Emeritus, Aichi Cancer Center. Also, the author would not be present as a physician without Dr. Masakazu Abe, the former Dean of the Jikei University School of Medicine, whose dedication and thoughtful approach to medicine has always led us.

Conflict of interest

Dr. Keisuke Aiba has received honoraria paid by a company as compensation (Ono Pharmaceutical Co.). Dr. Ken Uchida has received research funding from a company (Daiichi-Sankyo Pharma, clinical research on Sonazoid).

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Authors and Affiliations

  1. Department of Clinical Oncology and Hematology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Tadashi Kobayashi, Tamotsu Ichiba, Toshikazu Sakuyama, Yasuhiro Arakawa, Eijiroh Nagasaki & Keisuke Aiba

  2. Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Hiroko Nogi, Kazumi Kawase, Hiroshi Takeyama, Yasuo Toriumi & Ken Uchida

  3. Department of Therapeutic Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Masao Kobayashi & Chihiro Kanehira

  4. Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Masafumi Suzuki

  5. Department of Pharmacology, The Jikei University Hospital, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Naomi Ando

  6. Department of Hematology and Oncology, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan

    Kazuhiko Natori & Yasunobu Kuraishi

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  1. Tadashi Kobayashi
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  2. Tamotsu Ichiba
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  3. Toshikazu Sakuyama
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  7. Hiroko Nogi
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  8. Kazumi Kawase
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  9. Hiroshi Takeyama
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  10. Yasuo Toriumi
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  11. Ken Uchida
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  12. Masao Kobayashi
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Correspondence to Tadashi Kobayashi.

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Kobayashi, T., Ichiba, T., Sakuyama, T. et al. Possible clinical cure of metastatic breast cancer: lessons from our 30-year experience with oligometastatic breast cancer patients and literature review. Breast Cancer 19, 218–237 (2012). https://doi.org/10.1007/s12282-012-0347-0

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  • DOI: https://doi.org/10.1007/s12282-012-0347-0

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