Adjuvant therapy reduces the benefit of palliative treatment in disseminated breast cancer - own findings and review of the literature

TY - JOUR

T1 - Adjuvant therapy reduces the benefit of palliative treatment in disseminated breast cancer - own findings and review of the literature

AU - Kleeberg, Ulrich R

AU - Fink, Michael

AU - Tessen, Hans-Werner

AU - Nennecke, Alice

AU - Hentschel, Stefan

AU - Bartels, Stefan

N1 - © 2013 S. Karger GmbH, Freiburg.

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Adjuvant treatment concepts have improved the 10-year cure rate of breast and colon cancer, but new treatments for metastatic disease have yielded only incremental benefit. If treatments for disseminated cancer were actually prolonging life rather than only increasing remission rates, this effect should have been documented over the last 30+ years. However, published data concerning advances in treatment for disseminated cancer have been contradictory.PATIENTS AND METHODS: To add data-based information, we analyzed 2 sources: a regional population-based cancer registry (Hamburgisches Krebsregister, HKR), and a research cancer registry (Projektgruppe Internistische Onkologie, PIO). We compared the survival of several thousand patients with metastatic disease who received treatment only after dissemination with that of patients who received initial adjuvant therapy.RESULTS: After adjuvant treatment, survival in patients with disseminated breast cancer is up to a third shorter than that of patients without adjuvant therapy.CONCLUSIONS: In accordance with published evidence, we conclude that ineffective adjuvant treatment shortens survival after documentation of metastatic disease. This is probably due to the elimination of chemo-sensitive tumor cells or to the induction of resistance in remaining micrometatases. This negative effect on survival after dissemination has been shown clearly for breast cancer and is also probable for cancer of the colon and other sites.

AB - BACKGROUND: Adjuvant treatment concepts have improved the 10-year cure rate of breast and colon cancer, but new treatments for metastatic disease have yielded only incremental benefit. If treatments for disseminated cancer were actually prolonging life rather than only increasing remission rates, this effect should have been documented over the last 30+ years. However, published data concerning advances in treatment for disseminated cancer have been contradictory.PATIENTS AND METHODS: To add data-based information, we analyzed 2 sources: a regional population-based cancer registry (Hamburgisches Krebsregister, HKR), and a research cancer registry (Projektgruppe Internistische Onkologie, PIO). We compared the survival of several thousand patients with metastatic disease who received treatment only after dissemination with that of patients who received initial adjuvant therapy.RESULTS: After adjuvant treatment, survival in patients with disseminated breast cancer is up to a third shorter than that of patients without adjuvant therapy.CONCLUSIONS: In accordance with published evidence, we conclude that ineffective adjuvant treatment shortens survival after documentation of metastatic disease. This is probably due to the elimination of chemo-sensitive tumor cells or to the induction of resistance in remaining micrometatases. This negative effect on survival after dissemination has been shown clearly for breast cancer and is also probable for cancer of the colon and other sites.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Breast Neoplasms/mortality

KW - Carcinoma/mortality

KW - Chemotherapy, Adjuvant/mortality

KW - Evidence-Based Medicine

KW - Female

KW - Germany/epidemiology

KW - Humans

KW - Middle Aged

KW - Palliative Care/statistics & numerical data

KW - Prevalence

KW - Registries

KW - Risk Factors

KW - Survival Rate

KW - Treatment Outcome

U2 - 10.1159/000351253

DO - 10.1159/000351253

M3 - SCORING: Review article

C2 - 23774149

VL - 36

SP - 348

EP - 356

JO - ONKOLOGIE

JF - ONKOLOGIE

SN - 0378-584X

IS - 6

ER -