According to results recently presented at the VI Madrid Breast Cancer Conference and published in Breast Cancer Research, specific variables associated with a patient’s breast cancer significantly affect long-term outcomes for breast cancer patients undergoing high-dose therapy.
Patients who have a promising prognosis according to these variables may wish to proceed with high-dose therapy, while those whose diagnosis is associated with poorer outcomes according to these variables may wish to undergo alternative therapeutic strategies.
Women diagnosed with breast cancer whose cancer has spread to several lymph nodes under the arm (axillary nodes) and those classified with inflammatory breast cancer have a greater than 50% risk of experiencing a cancer recurrence following standard-dose chemotherapy. Due to the prevalence of relapse in these patients, several studies have evaluated the use of high-dose therapy in an attempt to improve outcomes in both groups of patients.
Unfortunately, results from these studies have not provided a clear indication as to the overall benefits of a high-dose treatment approach; however, it appears that some patients may derive significant benefit from high-dose therapy compared to standard doses. Therefore, researchers have been evaluating possible patient or disease characteristics that may be associated with specific outcomes following high-dose therapy, to provide a platform for individualized treatment for these patients.
Researchers from Spain recently analyzed data from clinical trials that evaluated high-dose therapy in women with breast cancer that had spread to several axillary lymph nodes, or those with inflammatory breast cancer. The data analyzed included 264 patients with an average follow-up of approximately 7 years.
Several variables were discovered that placed patients into low-risk, intermediate-risk or high-risk of developing a cancer recurrence following high-dose therapy:
• Number of lymph nodes to which the cancer had spread
• Size of the cancer
• Hormone receptor status
• Overexpression of the human epidermal growth factor receptor-2 (HER2)
• Overexpression of the epidermal growth factor receptor (EGFR), particularly among those who overexpressed HER2
• Presence of cancer cells in the apheresis product (removal and separation of whole blood into desired components)
(According to these variables, patients considered to be low-risk had an 87% relapse-free survival, those at intermediate-risk had a 68% relapse-free survival, and those at high risk had a 49% relapse-free survival at approximately 7years follow-up.)
The researchers concluded that specific cancer variables are strongly associated with outcomes following high-dose therapy in women with breast cancer that has spread to several axillary lymph nodes or those with inflammatory breast cancer.
Patients who are considered to have a low risk of developing a recurrence following high-dose therapy may wish to proceed with this treatment strategy, while those considered to have a high risk of developing a recurrence following high-dose therapy may wish to pursue alternative treatment strategies.
Future clinical trials are warranted to further evaluate high-dose therapy in the treatment of breast cancer, as this treatment approach still remains controversial. However, with the identification of specific variables that help predict outcome following this treatment approach, individualized treatment approaches appear warranted. It is important for patients with breast cancer to discuss their individual risks and benefits of all treatment options with their physician.
Reference: Nieto Y, et al. Prognostic studies in patients with high-risk primary breast cancer (HRPBC) receiving high-dose chemotherapy (HDC). Proceedings from the VI Madrid Breast Cancer Conference. June 2005. Madrid, Spain. Breast Cancer Research 2005, 7(Suppl 1):S22.