Liver
metastases have long been known to indicate an unfavourable disease course in
breast cancer (BC). However, a small subset of patients with liver
metastases alone who were treated with pre-
taxane chemotherapy regimens was reported to have longer survival compared with patients with liver and
metastases at other sites. In the present study, we examined the clinical outcome of
breast cancer patients with liver
metastases alone in the context of two phase III European Organisation for Research and Treatment of
Cancer (EORTC) trials which compared the efficacy of
doxorubicin (A) versus
paclitaxel (T) (trial 10923) and of AC (
cyclophosphamide) versus AT (trial 10961), given as first-line
chemotherapy in metastatic BC patients. The median follow-up for the patients with liver
metastases was 90.5 months in trial 10923 and 56.6 months in trial 10961. Patients with liver
metastases alone comprised 18% of all patients with liver
metastases, in both the 10923 and 10961 trials. The median survival of patients with liver
metastases alone and liver plus other sites of
metastases were 22.7 and 14.2 months (log rank test, P=0.002) in trial 10923 and 27.1 and 16.8 months (log rank test, P=0.19) in trial 10961. The median
TTP (time to progression) for patients with liver
metastases alone was also longer compared with the liver plus other sites of
metastases group in both trials: 10.2 versus 8.8 months (log rank test, P=0.02) in trial 10923 and 8.3 versus 6.7 months (log rank test, P=0.37) in trial 10961. Most patients with liver
metastases alone have progression of their disease in their liver again (96 and 60% of patients in trials 10923 and 10961, respectively). Given the high prevalence of
breast cancer, improved detection of liver
metastases, encouraging survival achieved with currently available
cytotoxic agents and the fact that a significant portion of patients with liver
metastases alone have progression of their tumour in the liver again, a more aggressive multimodality treatment approach through prospective clinical trials seems worth exploring in this specific subset of women.