Primary tumor resection to improve survival and local disease control in stage IV inflammatory breast cancer.

1102 Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer typically presenting with early metastasis. Optimal outcomes are achieved with multimodality treatment strategies in the non-metastatic setting. Data is limited, however, on the benefit of surgery in patients with metastatic IBC. We evaluated the effect of primary tumor resection on outcomes in patients with newly diagnosed stage IV IBC. Methods: We reviewed records of 172 patients with metastatic IBC treated at our institution from 1994 - 2009. All patients received systemic therapy with or without locoregional therapy (LRT). Patient demographics, receptor (ER) and HER2-neu status, grade, histology, presence of lymphovascular invasion, margin status, number of distant disease sites, pathologic response of primary tumor and clinical response to systemic therapy (CRS) at distant disease sites were recorded. Overall survival (OS), distant progression-free survival (DPFS), and chest/skin involvement at last follow-up were evaluated. Kaplan-Meier survival analyses, univariate (UV) and multivariate (MV) logistic regression models were used. Chest/skin involvement was compared between groups using Kruskal-Wallis test. Results: Seventy-nine (45%) patients underwent primary tumor resection. Average age was 51 (22-78). Median live-patient follow-up was 33 months. OS and DPFS were significantly better for patients who underwent LRT versus none (p<0.0001). Factors associated significantly for improved DPFS on MV analysis were ER and HER2-neu status (HR 0.61,0.60 p=0.02,0.05 ,respectively), LRT (HR .38, p=0.002) and CRS (HR 0.62, p=0.03). ER status (HR .45, p<0.001), LRT (HR .30, p<0.001) and CRS (HR 0.54, p=0.02) were significant predictors for higher OS on MV analysis. At last follow up, chest/skin involvement was moderate/severe in 11% of patients in LRT group versus 35% of patients in no LRT group (p<0.0001). Conclusions: This latest retrospective study demonstrates metastatic IBC patients who undergo LRT in addition to systemic therapy may have improved survival and local control outcomes. CRS may be used to guide LRT. A prospective randomized trial is needed to validate these findings.

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A randomized controlled trial comparing primary tumor resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (JCOG1017 PRIM-BC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.tps588 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. TPS588-TPS588 ◽

Cited By ~ 1

Author(s):

Tadahiko Shien ◽

Tomonori Mizutani ◽

Kiyo Tanaka ◽

Takayuki Kinoshita ◽

Fumikata Hara ◽

...

Keyword(s):

Breast Cancer ◽

Systemic Therapy ◽

Primary Tumor ◽

Tumor Resection ◽

Metastatic Breast ◽

Stage Iv ◽

Primary Tumor Resection ◽

Her2 Status ◽

Free Survival ◽

Stage Iv Breast Cancer

TPS588 Background: The possibility of improving the survival of stage IV breast cancer patients by primary tumor resection (PTR) has been reported by several retrospective studies; however, these studies essentially suffer from biases such as arbitrary patient selection, diverse timing of surgery or various regimens of systemic therapy. Five prospective randomized trials including our trial have evaluated the efficacy of PTR for them. Two have reported final results, but those results were inconsistent. Therefore, this subject still remains a hotly debated topic at major breast conferences. Methods: Our trial is being conducted to confirm the superiority of PTR plus systemic therapy over systemic therapy alone in stage IV pts who are sensitive to primary systemic therapy (PST) in this study. The inclusion criteria are untreated pts with histologically confirmed invasive breast cancer with one or more measurable distant metastatic lesions diagnosed by radiological examination.All pts receive PST according to the ER and HER2 status of the primary breast cancer after the first registration. After three months, the pts who are sensitive to PST are randomized to the PTR plus systemic therapy arm or the systemic therapy alone arm. After randomization and surgery in the former arm, or after randomization in the latter arm, the same systemic therapies are continued until progression of diseases and next appropriate regimens are started after that. The primary endpoint is the overall survival, and the secondary endpoints are proportion of pts without tumor progression at the metastatic sites, yearly local recurrence-free survival, proportion of local ulcer/local bleeding, yearly primary tumor resection-free survival, adverse events (AEs) of chemotherapy, operative morbidity, and serious AEs. Sample size for randomized pts was determined to attain at least 80% of power to detect a 6 months difference with one-sided alpha of 0.05.The pts accrual was started in May 2011. Enrollment of 410 pts for randomization is planned over a 7-year accrual period. 307 pts have been randomized until Jan 2017. This trial was registered at UMIN-CTR[umin.ac.jp/ctr/] as UMIN000005586. Clinical trial information: UMIN000005586.

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Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage IV inflammatory breast cancer

Cancer ◽

10.1002/cncr.28550 ◽

2014 ◽

Vol 120 (9) ◽

pp. 1319-1328 ◽

Cited By ~ 31

Author(s):

Catherine L. Akay ◽

Naoto T. Ueno ◽

Gary B. Chisholm ◽

Gabriel N. Hortobagyi ◽

Wendy A. Woodward ◽

...

Keyword(s):

Breast Cancer ◽

Inflammatory Breast Cancer ◽

Local Control ◽

Primary Tumor ◽

Tumor Resection ◽

Stage Iv ◽

Multimodality Treatment ◽

Primary Tumor Resection

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Could Primary Tumor Resection Improve Survival in Metastatic Breast Cancer?

International Journal of Scientific Research and Management ◽

10.18535/ijsrm/v9i07.mp04 ◽

2021 ◽

Vol 9 (07) ◽

pp. 422-428

Author(s):

Rafaela Aparecida Dias de Oliveira ◽

Lyvia Aparecida Dias de Oliveira ◽

Marília Davoli Abella Goulart ◽

Maria Clara Faustino Linhares

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Metastatic Breast Cancer ◽

Systemic Therapy ◽

Primary Tumor ◽

Tumor Resection ◽

Metastatic Breast ◽

Progression Free Survival ◽

Primary Tumor Resection ◽

Free Survival

Introduction: In advanced breast cancer, local treatment is considered palliative. However, although there are some polemic opinions about the surgical treatment, some of the latest studies have emphasized that in advanced cases primary tumor resection (PTR) is related to better outcomes. This review aims to evaluate how resection of the original tumor impacts women with metastatic breast cancer, considering the most recent studies about this subject. Methods: The search was performed in MEDLINE, Scopus, PMC, Current Contents and Wiley Online Library databases; 23 articles - from 2016 to 2019 - were selected and 11 were included in this review. As inclusion criteria were considered: studies presenting outcomes about resection of the primary tumor, comparison between chemotherapy/ hormone therapy/ targeted cancer therapies and surgical intervention, studies published from 2016 to 2019 and available in English, Spanish or Portuguese. We excluded those which did not approach PTR, did not present outcomes of interest (progression-free survival comparison between PTR and systemic therapy) or only discussed systemic therapy, as well as those published before 2016. Results: It was reported in 6 studies that progression-free survival is better on those who underwent surgery. PTR was also related to longer median overall survival in women submitted to surgery, up to 16 months higher when compared to the ones who were not. Enhanced survival even pertained to surgical groups regardless of tumor size. Conclusion: Based in the analysis, PTR in metastatic breast cancer can be related to higher overall survival.

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