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Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature

  • Epidemiology
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Approximately 6 % of patients with breast cancer are diagnosed with de-novo distant metastases. We set out to look at two cohorts of patients seen at breast cancer-specific practices, compare the results to other reports and larger databases, and see how advances in treatment have impacted overall survival (OS). The records from a large breast cancer oncology private practice and a second data set from the University of Miami/Sylvester Comprehensive Cancer Center (UM/SCCC) tumor database were, retrospectively, reviewed to identify patients with de-novo metastases. We included those patients identified to have metastatic disease within 3 months of diagnosis of a breast primary cancer. Patients diagnosed between 1996 and 2006 were chosen for our study population. The OS for the private practice was 41.0 months (46.0 for ER positive and 26.0 for ER negative) and 36.0 months for UM/SCCC (52 months for ER positive and 36 months for ER negative). ER negativity and CNS- or visceral-dominant disease were associated with a significantly worse prognosis within the private practice. Dominant site was associated with a significantly worse prognosis within the UM/SCCC database but with a trend also for ER negativity. Age and ethnicity did not contribute significantly to the survival of patients within either cohort. The median survival in both cohorts and most other reported series was larger than that seen in the surveillance, epidemiology, and end results program and the National Cancer Database. The median OS among patients with de-novo metastatic breast cancer treated within two breast-specific oncology practices was over 3 years, which appears better than larger, more inclusive databases and publications from earlier decades.

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  1. Howlader N, Noone AM, Krapcho M et al (2013) SEER Cancer Statistics Review, 1975-2010, National Cancer Institute, Bethesda. Based on November 2012 SEER data submission, posted to the SEER web site

  2. Dawood S, Broglio K, Ensor J et al (2010) Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol 21(11):2169–2174. doi:10.1093/annonc/mdq220

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Lobbezoo DJA, van Kampen RJW, Voogd AC et al (2015) Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer? Br J Cancer 112(9):1445–1451. doi:10.1038/bjc.2015.127

    Article  CAS  PubMed  Google Scholar 

  4. Rahman Z, Frye D, Smith T (2000) Results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with standard dose doxorubicin containing chemotherapy. Cancer 40(19990101):1–2

    CAS  Google Scholar 

  5. Nieto Y, Nawaz S, Jones RB et al (2002) Prognostic model for relapse after high-dose chemotherapy with autologous stem-cell transplantation for stage IV oligometastatic breast cancer. J Clin Oncol 20(3):707–718

    Article  CAS  PubMed  Google Scholar 

  6. Dawood S, Broglio K, Gonzalez-Angulo AM et al (2008) Trends in survival over the past two decades among white and black patients with newly diagnosed stage IV breast cancer. J Clin Oncol 26(30):4891–4898. doi:10.1200/JCO.2007.14.1168

    Article  PubMed Central  PubMed  Google Scholar 

  7. Hortobagyi GN (2002) Can we cure limited metastatic breast cancer? J Clin Oncol 20(3):620–623

    PubMed  Google Scholar 

  8. Andre F, Slimane K, Bachelot T et al (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22(16):3302–3308. doi:10.1200/JCO.2004.08.095

    Article  PubMed  Google Scholar 

  9. Güth U, Magaton I, Huang DJ, Fisher R, Schötzau A, Vetter M (2014) Primary and secondary distant metastatic breast cancer: two sides of the same coin. Breast 23(1):26–32. doi:10.1016/j.breast.2013.10.007

    Article  PubMed  Google Scholar 

  10. Friedel G, Pastorino U, Ginsberg RJ et al (2002) Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the international registry of lung metastases. Eur J Cardio-thorac Surg 22(3):335–344

    Article  Google Scholar 

  11. Chia SK, Speers CH, D’yachkova Y et al (2007) The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer 110(5):973–979. doi:10.1002/cncr.22867

    Article  PubMed  Google Scholar 

  12. Zinser JW, Hortobagyi GN, Buzdar AU, Smith TL, Fraschini G (1987) Clinical course of breast cancer patients with liver metastases. J Clin Oncol 5(5):773–782

    CAS  PubMed  Google Scholar 

  13. Sledge GW, Neuberg D, Bernardo P et al (2003) Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as frontline chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J Clin Oncol 21:588–592

    Article  PubMed  Google Scholar 

  14. Brufman G, Colajori E, Ghilezan N et al (1997) Doubling epirubicin dose intensity (100 mg/m2 versus 50 mg/m2) in the FEC regimen significantly increases response rates. An international randomised phase III study in metastatic breast cancer. The epirubicin high dose (HEPI 010) study group. Ann Oncol 8(2):155–162

    Article  CAS  PubMed  Google Scholar 

  15. Slamon DJ, Leyland-Jones B, Shak S et al (2001) Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 344:783–792

    Article  CAS  PubMed  Google Scholar 

  16. Aisner J, Cirrincione C, Perloff M et al (1995) Combination chemotherapy for metastatic or recurrent carcinoma of the breast—a randomized phase III trial comparing CAF versus VATH versus VATH alternating with CMFVP: Cancer and Leukemia Group B Study 8281. J Clin Oncol 13(6):1443–1452

    CAS  PubMed  Google Scholar 

  17. Estaban E, Lacave AJ, Fernández JL et al (1999) Phase III trial of cyclophosphamide, epirubicin, fluorouracil (CEF) versus cyclophosphamide, mitoxantrone, fluorouracil (CNF) in women with metastatic breast cancer. Breast Cancer Res Treat 58(2):141–150

    Article  CAS  PubMed  Google Scholar 

  18. Pacini P, Rinaldini M, Algeri R et al (2000) FEC (5-fluorouracil, epidoxorubicin and cyclophosphamide) versus EM (epidoxorubicin and mitomycin-C) with or without lonidamine as first-line treatment for advanced breast cancer. A multicentric randomised study. Final results. Eur J Cancer 36(8):966–975

    Article  CAS  PubMed  Google Scholar 

  19. Lee T, Isaacs C (2014) Treatment of primary breast tumors in de novo metastatic breast cancer. Clin Adv Hematol Oncol 12(12):820–827

    PubMed  Google Scholar 

  20. Dominici L, Najita J, Hughes M et al (2011) Surgery of the primary tumor does not improve survival in stage IV breast cancer. Breast Cancer Res Treat 129(2):459–465

    Article  PubMed Central  PubMed  Google Scholar 

  21. Rapiti E, Verkooijen HM, Vlastos G et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24(18):2743–2749

    Article  PubMed  Google Scholar 

  22. Shien T, Nakamura K, Shibata T et al (2012) A randomized controlled trial comparing primary tumour resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (PRIM-BC): Japan Clinical Oncology Group Study JCOG1017. Jpn J Clin Oncol 42(10):970–973

    Article  PubMed  Google Scholar 

  23. Babiera GV, Rao R, Feng L et al (2006) Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol 13(6):776–782

    Article  PubMed  Google Scholar 

  24. Infante JR, Yardley DA, Burris HA 3rd et al (2009) Phase II trial of weekly docetaxel, vinorelbine, and trastuzumab in the first-line treatment of patients with HER2-positive metastatic breast cancer. Clin Breast Cancer 9(1):23–28

    Article  CAS  PubMed  Google Scholar 

  25. Berghoff AS, Bago-Horvath Z, Dubsky P et al (2013) Impact of HER-2-targeted therapy on overall survival in patients with HER-2 positive metastatic breast cancer. Breast J 19(2):149–155. doi:10.1111/tbj.12070

    Article  CAS  PubMed  Google Scholar 

  26. Gennari A, Amadori D, De Lena M et al (2006) Lack of benefit of maintenance paclitaxel in first-line chemotherapy in metastatic breast cancer. J Clin Oncol 24(24):3912–3918

    Article  CAS  PubMed  Google Scholar 

  27. Bertaut A, Mounier M, Desmoulins I et al (2015) Stage IV breast cancer: a population-based study about prognostic factors according to HER2 and HR status. Eur J Cancer Care (Engl). doi:10.1111/ecc.12306

    Google Scholar 

  28. Rossi V, Nolè F, Redana S et al (2014) Clinical outcome in women with HER2-positive de novo or recurring stage IV breast cancer receiving trastuzumab-based therapy. Breast 23(1):44–49. doi:10.1016/j.breast.2013.10.005

    Article  PubMed  Google Scholar 

  29. Vaz-Luis I, Lin NU, Keating NL et al (2015) Racial differences in outcomes for patients with metastatic breast cancer by disease subtype. Breast Cancer Res Treat 151(3):697–707. doi:10.1007/s10549-015-3432-1

    Article  PubMed  Google Scholar 

  30. Yardley DA, Kaufman PA, Brufsky A et al (2014) Treatment patterns and clinical outcomes for patients with de novo versus recurrent HER2-positive metastatic breast cancer. Breast Cancer Res Treat 145(3):725–734. doi:10.1007/s10549-014-2916-8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. National Cancer Data Base. American College of Surgeons. Accessed August 1st, 2014

  32. Zeichner SB, Ambros T, Zaravinos J et al (2015) Defining the survival benchmark for breast cancer patients with systemic relapse. Breast Cancer (Auckl) 9:9–17

    PubMed Central  Google Scholar 

  33. Parise CA, Bauer KR, Brown MM, Caggiano V (2009) Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999-2004. Breast J 15(6):593–602. doi:10.1111/j.1524-4741.2009.00822.x

    Article  PubMed  Google Scholar 

  34. Carey LA, Perou CM, Livasy CA et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502. doi:10.1001/jama.295.21.2492

    Article  CAS  PubMed  Google Scholar 

  35. Cancer Rates by Race/Ethnicity and Sex. Division of Cancer Prevention and Control. Centers for Disease Control and Prevention. Accessed Aug 5, 2015

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Correspondence to Simon B. Zeichner.

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Zeichner, S.B., Herna, S., Mani, A. et al. Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature. Breast Cancer Res Treat 153, 617–624 (2015).

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