New cytotoxic, biologic agents have not improved survival for patients with distant recurrence
A review of adjuvant phase 3 trials conducted over a 24-year period demonstrated no general survival improvement for patients who developed distant breast cancer recurrence following adjuvant therapy.
Population-based studies have indicated that, over time, survival has improved in patients with metastatic breast cancer. That improvement most likely is because new and more effective treatments are available, researchers said.
Amye J. Tevaarwerk
In the current study, Amye J. Tevaarwerk, PhD, of the Medical Oncology Clinic at the University of Wisconsin Carbone Comprehensive Cancer Center in Madison, Wis., and colleagues assessed survival after recurrence in participants of Eastern Cooperative Oncology Group (ECOG) clinical trials conducted from 1978 to 2002.
Tevaarwerk and colleagues included 11 phase 3 adjuvant breast cancer trials in their analysis. All trials involved at least 5 years of follow-up.
Of the 13,785 patients included in this study, 3447 patients developed distant disease recurrence. Median survival after recurrence was 20 months (95% CI, 19-21).
There were several factors associated with poorer survival. They included a shorter distant recurrence-free interval (DRFI), estrogen receptor-negative and progesterone receptor-negative disease, the number of positive axillary lymph nodes present at the time of diagnosis, and African-American race (P<.0001 for all).
Over time, survival improved only in patients with hormone receptor-negative disease who had a recurrence within 3 years of their initial diagnosis. Researchers observed that association both among the most recent five trials (P=.01) and the entire trial data set (P=.05).
“In contrast to reports from population-based studies, no general improvement in survival was observed over the last 30 years for patients who developed distant disease recurrence after adjuvant chemotherapy after adjusting for DRFI,” Tevaarwerk and colleagues wrote. “Improved survival for patients with hormone receptor-negative disease with a short DRFI suggests a benefit from trastuzumab.”