MedicalResearch.com Interview with:
Judith A. Malmgren, PhD
President, HealthStat Consulting, Inc
University of Washington
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Metastatic breast cancer (MBC) has two types, de novo stage IV MBC discovered to be metastatic at initial diagnosis as advanced disease and recurrent MBC found on follow up after diagnosis and treatment for initial invasive breast cancer. Our institutional breast cancer registry tracks both de novo metastatic breast cancer and invasive breast cancer for distant metastases. With this information we were able to compare the presentation, treatment and outcomes of both types, something that is not possible in national SEER data as recurrent MBC is not tracked.
We found a remarkable improvement in 5-year survival from 28% to 55% over time among the de novo metastatic breast cancer patients. Recurrent MBC 5-year survival did not improve in the same time period (23% to 13%) although incidence of recurrent MBC fell from 18% to 7% from 1990 to 2010. Incidence of recurrent metastatic breast cancer hormone receptor and HER2 positive breast cancer declined the most, leaving a large number of triple-negative recurrent metastatic breast cancer cases in the most recent time period.
Worse metastatic breast cancer survival was associated with recurrent vs. de novo MBC, hormone receptor negative disease, older age (70+) and visceral dominant disease. HER2 positive disease was associated with better outcomes.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: The possibility for improved survival exists for de novo metastatic breast cancer with appropriate treatment. Recurrent metastatic breast cancer still presents a very tough clinical treatment situation with poor prognosis made worse by prior treatment and fewer options available for older age and triple negative breast cancer patients. Caution may be warranted when combining de novo and recurrent breast cancer outcomes in clinical trials. Adjusting outcomes by de novo vs recurrent MBC type will best represent treatment efficacy as the two types appear to have differential response to treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: By comparison the institutional cohort improvement in de novo metastatic breast cancer survival we observed over time surpasses the improvements seen in the US population from SEER data by 20% (Jemal A, JNCI 2017. doi: 10.1093/jnci/djx030, 16-1514R1_Jemal_supp_mat_020717_djx030). Identification of reasons for absence of comparable improvement nationally could be used to inform treatment decisions for de novo metastatic breast cancer. With the drop in recurrent metastatic breast cancer incidence but worse overall survival, treatment for distant recurrence especially in triple negative breast cancer after recurrence and at initial diagnosis is of utmost importance.
Disclosures: The authors have no conflicts of interest to report.
This research was funded by the Kaplan Cancer Research Fund and the Metastatic Breast Cancer Alliance.
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Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010.
Malmgren JA1,2, Mayer M3, Atwood MK4, Kaplan HG4.
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