Today is day #2 of the San Antonio Breast Symposium, and investigators from Tata Memorial Hospital (India) provided some provocative data regarding the management of patients with metastatic breast cancer at the time of initial diagnosis. Here are their findings:
Summary: Loco-regional treatment of the primary tumor and axillary nodes has no impact on overall survival among patients with metastatic breast cancer at initial presentation, who have responded to frontline chemotherapy. Such treatment should be reserved for women who need it for palliative (symptom relief) reasons.
The Study: Women with metastatic breast cancer at initial diagnosis and planned to be treated with anthracycline-based chemotherapy (CT) were registered for the study. Those who had an objective tumor response after 6 cycles of CT were randomized to one of the following arms: ‘LRT’ (loco-regional treatment) or ‘No-LRT’ (no loco-regional treatment).
- Patients were stratified by endocrine receptor (ER) status, site of metastases (visceral vs bone vs both) and number of metastatic lesions (< 3 vs > 3).
- Women in the LRT arm received surgery (breast conservation or mastectomy plus axillary lymph node dissection) followed by radiation therapy (RT). Women in the No-LRT arm were followed (without surgery and RT).
- Both groups received standard endocrine therapy after the last cycle of chemotherapy, if indicated.
- 350 women were randomized, 173 to LRT and 177 to No-LRT.
Results: The median overall survival in the LRT and No-LRT arms were 18.8 and 20.5 months (HR=1.07, 95%CI=0.82-1.40, P=0.60) and the corresponding 2-year OS were 40.8% and 43.3%, respectively.
My Take: This study, albeit small in number of patients, suggests that, for patients with distant metastases at breast cancer diagnosis, there is no benefit from aggressive treatment of the breast and lymph nodes. I’m Dr. Michael Hunter.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.
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