Surgery may expand length of endurance for metastatic breast malignant growth patients

Overview

• Post By : Kumar Jeetendra


• Source: Penn State College of Medicine


• Date: 28 Dec,2020

They studied nearly 13,000 stage four breast cancer patients and found that those who had surgery as well as their other remedies had a survival advantage over those who had other therapies alone.

Stage four breast cancer accounts for 6% of newly-diagnosed breast cancer cases. Systemic treatment, which may include treatments like chemotherapy, hormone therapies and immunotherapies, is frequently part of treatment strategies for those individuals. The benefits of surgery to remove the primary breast cancer are only suggested for relieving symptoms of breast cancer such as pain and bleeding.

Surgery is the standard of care for several other types of cancers which have spread from the site of origin to another area of the body, known as metastatic cancers. Dr. Kelly Stahl, surgical resident and lead author of the research published in the Annals of Surgical Oncology, said that previous studies evaluating surgical interventions for metastatic breast cancer had conflicting results that has resulted in a lack of consensus among clinicians and researchers.

Results from previous trials evaluating surgical benefit in metastatic breast cancer patients have been questioned because of the small number of participants or the fact that patients weren’t also receiving chemotherapy or other systemic therapies. We felt another key factor missing from those studies was whether the biologic subtype of breast cancer affected the survival rates in relation to surgical intervention.”

Dr. Kelly Stahl, Surgical Resident, Study’s Lead Author

Stahl worked with Dr. Daleela Dodge and Chan Shen to identify 12,838 stage four breast cancer patients in the National Cancer Database from 2010-2015 and if these patients’ cancer cells had a growth-promoting protein known as HER2 and hormone receptors for progesterone and estrogen, which could fuel cancer growth. The researchers said understanding these characteristics of a cancer’s biological subtype will help determine which treatment plans could be effective.

Stahl studied patients who either had systemic treatment alone, had systemic therapy and surgery or had systemic treatment, surgery and radiation. She and her coauthors then evaluated whether specific biologic subtypes and time of chemotherapy were associated with survival advantages.

“We evaluated whether the hormone status had an influence on surgical benefit in those treatment-responsive breast cancer patients,” said Dodge, an associate professor of surgery and humanities. “Some types of breast cancer, especially like triple negative, where the cancer is hormone receptor and HER2 negative, aren’t very responsive to therapy. So our aim was to see if surgery made a difference in metastatic breast cancers which were responsive to treatment.”

The researchers excluded patients who died within six months of the diagnoses, to be able to make sure that treatment-responsive cancers were being studied. They found that patients with a surgical intervention tended to have a longer length of survival compared to patients with other treatment plans. Patients whose cancers were HER2 positive particularly saw prolonged survival when their treatment plan included operation.

Stahl and her coauthors further examined the patients who received surgery to find out whether getting chemotherapy before or after surgery had an impact on their length of survival. They found that regardless of hormone receptor or HER2 status, patients who received systemic therapy -; including chemotherapy and targeted treatments -; before surgery tended to live longer than those who had surgery before systemic treatment.

“Not only did we find that operation may be good for treatment-responsive metastatic breast cancer patients, we also discovered that getting chemotherapy before that operation had the greatest survival advantage in patients with positive HER2 and estrogen and progesterone receptor status,” said Shen, associate professor of surgery.

The researchers stated that randomized, controlled trials evaluating the role of surgery after systemic therapy at a younger demographic with minimally metastatic cancers could be used to confirm their results, but stated that patient immunity to randomization in trials such as this have caused poor study recruitment. Therefore, they encourage clinicians to evaluate real-world signs, including their analysis, to select optimal treatment for metastatic breast cancer patients.

“Stage four breast cancer patients who are responsive to systemic therapy may have the ability to benefit from the addition of operation no matter their biologic subtype,” Stahl said.