Chemotalk Newsletter, Vol. 90 October 1, 2015
I have other stories to report but they can wait. This story is really important and wildly exciting to me, and I'm using my bully pulpit to focus on it. I am one of these cancer patients diagnosed at the onset with stage 4 breast cancer. I am also someone who was diagnosed in 2005, although I am not part of this study. And I'm more than surviving, I'm thriving.
Realistically, I know that my cancer, or another cancer, could appear. Yet it seems to me that if this study was done on patients diagnosed 10 years ago, the actual survival rate may be even higher than this study indicates. There are new drugs, new treatments that extend the life of breast cancer patients. No breast cancer survivor is really safe, but some of us are safer than others.
I always hoped that "we", the lucky ones still alive and still healthy, would be studied. And I hope that this study is just the first. We don't necessarily hold the answers to breast cancer survival, but it's possible that we hold one of the keys. I am so grateful that researchers are looking into us, at last.
I promise that next month's newsletter will be more wide-ranging in scope of coverage.
Elaine Jesmer Editor, Chemotalk Newsletter
METASTATIC BREAST CANCER PATIENTS WHO ATTAIN NO EVIDENCE OF DISEASE LIVE LONGER
The attainment of ³no evidence of disease² (NED) after treatment for metastatic breast cancer (MBC) is significantly associated with prolonged survival, according to a new study. Patients who were HER2-positive in this group also survived longer than those who were estrogen receptor (ER) positive.
Previous studies have found that between 5% and 10% of MBC patients survive more than 5 years, and 2% to 5% live beyond 10 years. ³This albeit uncommon but distinctive subset challenges the belief that MBC is universally fatal,² wrote study authors led by Andrew J. Bishop, MD, of the University of Texas MD Anderson Cancer Center in Houston.
The new study aimed to characterize patients with MBC who attain NED status, to assess outcomes compared with those who do not. Results were published online ahead of print in Cancer.
Investigators reviewed results for 570 consecutive patients with MBC treated between January 2003 and December 2005. Ninety of these (16%) attained NED, which the researchers defined as a complete metabolic response on PET, or sclerotic healing of bone metastases on CT or MRI. The median follow-up period for those who attained NED status was 100 months.
For the full cohort of 570 patients, the 3-year survival rate was 44%, and the 5-year survival rate was 24%. In contrast, those survival rates in NED patients were 96% and 78%, respectively.
At 2 years, NED status was significantly associated with survival, with a hazard ratio (HR) for mortality of 0.23 (95% confidence interval [CI], 0.160.34; P < .001). This was similar at 3 years as well, with an HR of 0.20 (95% CI, 0.140.30; P < .001). The median survival for NED patients was 102 months from the time of attaining NED status, and the 5-year progression-free survival rate was 40%.
On multivariate analysis, patients who had HER2-positive disease had better overall survival than those with ER-positive disease, with an HR of 0.44 (95% CI, 0.210.90; P = .02). Trastuzumab use was significantly associated with progression-free survival.
After adjustments, several factors made it significantly less likely for a patient to achieve NED status: these included overweight and obesity, and triple-negative disease. Presenting with de novo MBC, having a single metastatic site vs multiple sites, and having undergone local treatment of the primary tumor were associated with an increased likelihood of NED status.
³Ultimately, this study provides findings to encourage further research into this subset of patients with MBC, and it provides a backbone of outcome data for clinicians to use when they are counseling patients who attain complete responses to treatment about potential outcomes,² the authors concluded. They noted that the retrospective design does limit the study¹s interpretation.
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See you in November...
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And if you have any thoughts of how this newsletter could be improved, please email me directly, at Elaine@elainejesmer.com.