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      Treatment Outcome and Prognostic Factors for Patients with Bone-Only Metastases of Breast Cancer: A Single-Institution Retrospective Analysis

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          Abstract

          The study defines prognostic factors for breast cancer patients with bone-only metastases and examines progression-free and overall survival times in patients with hormone receptor–positive disease and bone-only metastases treated with different therapies.

          Abstract

          Purpose.

          Limited information is available about the optimal management and clinical outcome of bone-only metastases in breast cancer patients. The objective of this study was to define prognostic factors for patients with bone-only metastases. Our second objective was to compare progression-free survival (PFS) and overall survival (OS) between patients with hormone receptor (HR) + tumors and bone-only metastases who received combinatory therapy (chemotherapy followed by endocrine therapy, or endocrine therapy combined with molecular targeted therapy) and those treated with endocrine or chemotherapy alone.

          Patients and Methods.

          We retrospectively identified 351 breast cancer patients diagnosed with bone-only metastasis in 1997–2008 at our institution.

          Results.

          Patients with metastasis detected at the time of their primary breast cancer diagnosis (rather than at recurrence), a single metastasis, or asymptomatic bone disease had a longer PFS interval, and patients with a performance status of 0–1, a single metastasis, or asymptomatic bone disease had a longer OS time. Among patients with HR + human epidermal growth factor receptor (HER)-2 − disease, combinatory therapy was associated with longer PFS and OS times than with endocrine therapy. In multivariate analyses, combinatory therapy was not associated with longer PFS or OS times than with endocrine therapy. Among patients with HER-2 + disease, trastuzumab led to a longer PFS interval but no difference in the OS time.

          Conclusion.

          Our results indicate that, for HR + disease, a prospective trial of chemotherapy followed by endocrine therapy is warranted to determine whether it prolongs survival more than endocrine therapy alone in patients with bone-only metastases.

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          Most cited references23

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          The clinical course of bone metastases from breast cancer.

          R Coleman, R D Rubens (1987)
          All patients with carcinoma of the breast seen in this Unit since 1970 were reviewed to study the incidence, prognosis, morbidity and response to treatment of bone metastases. The biological characteristics of the primary tumour were compared in patients relapsing first in bone or liver. Sixty-nine percent of patients dying with breast cancer had bone metastases and bone was the commonest site of first distant relapse. Bone relapse was more common in receptor positive or well differentiated (grade 1) tumours. The median survival was 24 months in those with disease apparently confined to the skeleton compared with 3 months after first relapse in liver. Ten percent of patients with breast cancer developed hypercalcaemia. All had metastatic disease and 85% had widespread skeletal involvement. Fifteen percent of patients with disease confined to the skeleton developed hypercalcaemia. The response in bone to primary endocrine therapy, and chemotherapy, was apparently less than the overall response achieved. A large proportion had apparently static disease reflecting the insensitivity of the UICC assessment criteria. The duration of survival in these patients was similar to responding patients, suggesting a tumour response may occur in the absence of discernable radiological evidence of healing.
          Article 0 comments Cited 205 times – based on 0 reviews     Review now
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            Treatment of breast cancer.

            Gabriel N Hortobagyi (1998)
            Article 0 comments Cited 123 times – based on 0 reviews     Review now
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              Phase II study of weekly docetaxel and trastuzumab for patients with HER-2-overexpressing metastatic breast cancer.

              Vicente Valero, Daniel J Booser, Christopher Murray … (2002)
              To evaluate the safety and efficacy of weekly docetaxel plus trastuzumab in women with HER-2-overexpressing metastatic breast cancer. Efficacy was correlated with serum HER-2 extracellular domain (ECD) levels. Thirty women with metastatic breast cancer were treated with weekly docetaxel and trastuzumab as first- or second-line therapy. Both docetaxel 35 mg/m(2)/wk and trastuzumab 2 mg/kg/wk were delivered in 4-week cycles consisting of three weekly treatments followed by 1 week of rest. A loading dose of trastuzumab 4 mg/kg was administered 1 day before the start of the first cycle. The median delivered dose-intensity of docetaxel was 24 mg/m(2)/wk (range, 18 to 27 mg/m(2)/wk). The intent-to-treat overall response rate (ORR) was 63% (95% confidence interval [CI], 44% to 80%). The ORR in patients whose tumors were HER-2-positive by fluorescence in situ hybridization was 67% (16 of 24 patients; 95% CI, 45% to 84%). In patients with elevated serum HER-2 ECD at baseline, the ORR was 76% (95% CI, 53% to 92%), compared with 33% (95% CI, 7% to 70%) in patients with low HER-2 ECD levels (P =.04). Variations in HER-2 ECD concentrations during treatment correlated with response to treatment. Median time to progression was 9 months. Acute toxicity, including myelosuppression, was mild. Fatigue, fluid retention, and excessive tearing became more common with repetitive dosing. Weekly docetaxel and trastuzumab is an active combination for treating patients with HER-2-overexpressing metastatic breast cancer. Serum HER-2 ECD testing may be a promising method for monitoring patients on trastuzumab-based therapy.
              Article 0 comments Cited 91 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Oncologist
                Journal ID (iso-abbrev): Oncologist
                Journal ID (pmc): oncologist
                Journal ID (hwp): theoncologist
                Journal ID (publisher-id): The Oncologist
                Title: The Oncologist
                Publisher: AlphaMed Press (Durham, NC, USA )
                ISSN (Print): 1083-7159
                ISSN (Electronic): 1549-490X
                Publication date (Print): February 2011
                Publication date (Electronic): 25 January 2011
                Volume: 16
                Issue: 2
                Pages: 155-164
                Affiliations
                [1]Departments of aBreast Medical Oncology and
                [2] bBiostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;
                [3] cDepartment of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
                Author notes
                Correspondence: Richard L. Theriault, D.O., F.A.C.P., Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, Texas 77030, USA. Telephone: 713-792-2817; Fax: 713-794-4385; e-mail: rtheriau@ 123456mdanderson.org or Naoto T. Ueno, M.D., Ph.D., F.A.C.P., Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, Texas 77030, USA. Telephone: 713-792-8754; Fax: 713-794-4385; e-mail: nueno@ 123456mdanderson.org

                Disclosures: Naoki Niikura: None; Jun Liu: None; Naoki Hayashi: None; Shana L. Palla: None; Yutaka Tokuda: None; Gabriel N. Hortobagyi: Consultant/advisory role: Allergan, Genentech, Merck, Novartis, sanofi-aventis, Taivex; Research funding/contracted research: Novartis; Naoto T. Ueno: Honoraria: Novartis; Research funding/contracted research: EUSA; Richard L. Theriault: None.

                The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

                Article
                Publisher ID: 3675353
                DOI: 10.1634/theoncologist.2010-0350
                PMC ID: 3228079
                PubMed ID: 21266401
                SO-VID: 96eb40b8-714c-44c1-a9dc-30ff45638fd0
                Copyright © ©AlphaMed Press
                License:

                available online without subscription through the open access option.

                History
                Date received : 19 October 2010
                Date accepted : 19 December 2010
                Categories
                Subject: Breast Cancer

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer,bone metastases,prognostic factor
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer, bone metastases, prognostic factor

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