Primary Tumor Treatment Doesn’t Improve Survival in Metastatic Breast Cancer

MedicalResearch.com Interview with:
Dr. R. A. Badwe, MS

Director, Tata Memorial Centre
E. Borges Marg, Parel
Mumbai -India 

Medical Research: What is the background for this study? What are the main findings?

Response:   The available retrospective clinical data suggested an overall survival benefit for metastatic breast cancer patients treated with surgery, with or without radiation, for the primary breast tumor. These studies were fraught with biases and at the same time, studies showed  removal of the primary tumor improved survival in patients with metastatic renal cell carcinoma. Additionally data from animal experiments suggested that surgical removal of the primary tumor could potentially increase metastatic spread.

Our study was thus planned to address the uncertainty on role of surgery of the primary in women presenting with metastatic breast cancer.

The main findings of this study suggest that there is no evidence to suggest that loco-regional treatment of the primary tumor confers an overall survival advantage in patients with de-novo metastatic breast cancer and this procedure should not be routinely done. Additionally, we noted though there was significant local control in the loco regional treatment arm, there was a detriment in distant progression-free survival and no difference in overall survival.

Medical Research: What should clinicians and patients take away from your report?

Response: Loco-regional treatment of the primary tumor does not have any overall survival advantage in patients with de-novo metastatic breast cancer and this procedure should not be routinely done. Surgery of the primary tumor in these patients would be reserved to palliate symptoms such as fugation or bleeding.

Medical Research: What recommendations do you have for future research as a result of this study?

Response:   There was a detriment in distant progression-free survival in women who received loco-regional treatment compared with those who did not. This finding is consistent with the results of preclinical studies , which showed growth of a metastatic tumor subsequent to the removal of the primary tumor.

The possible hypothesis for the same include, surgical dissemination, increased adhesion of circulating tumor cells, surgery-induced immunosuppression, surgery- induced angiogenic switch, or the inflammatory cascade.

Future research should be directed to whether a similar growth advantage might also be conferred to micro-metastatic disease in early breast cancer and whether peri-operative interventions can lead to a long-term survival advantage.

Citation:

Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial

Badwe, Rajendra et al.

The Lancet Oncology , Volume 16 , Issue 13 , 1380 – 1388

Published Online: 09 September 2015

DOI: http://dx.doi.org/10.1016/S1470-2045(15)00135-7

 

Dr. R. A. Badwe, MS (2015). Primary Tumor Treatment Doesn’t Improve Survival in Metastatic Breast Cancer