Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support.

Abstract

PURPOSE:

We performed a retrospective review to determine predictive and prognostic factors in patients with metastatic breast cancer who received induction therapy, and, if they responded to treatment, high-dose chemotherapy.

PATIENTS AND METHODS:

Patients with metastatic breast cancer received induction therapy with doxorubicin, fluorouracil, and methotrexate (AFM). Partial responders then received immediate high-dose chemotherapy, whereas those who achieved complete remission were randomized to immediate or delayed high-dose chemotherapy with hematopoietic stem-cell support. We performed a retrospective review of data from these patients and used Cox proportional hazards regression models for analyses.

RESULTS:

The overall response rate for the 425 patients enrolled was 74% (95% confidence interval, 70% to 78%). Multivariate analysis of data from all 425 patients revealed that positive estrogen receptor status (P =.0041), smaller metastatic foci (</= 2 v > 2 cm) (P =. 0165), a longer disease-free interval from initial diagnosis to diagnosis of metastases (</= 2 v > 2 years) (P =.0051), and prior treatment with tamoxifen (P =.0152) were good prognostic signs for overall survival. Patients who had received prior adjuvant therapy (P =.0001) and those who developed liver metastases (P =.0001) had decreased long-term survival. In the subgroup of responders to AFM induction, multivariate analysis showed that those with visceral metastases did less well (P =.0006), as did patients who had received prior adjuvant therapy (P =.0023). However, those who had received tamoxifen therapy in the adjuvant setting did better (P =. 0143).

CONCLUSION:

The chance for long-term remission with induction therapy with AFM and high-dose chemotherapy is increased for hormone receptor positive-patients with nonvisceral metastases who have not received prior adjuvant chemotherapy and have long disease-free intervals.

• Authors: D A Rizzieri, J J Vredenburgh, R Jones, M Ross, E J Shpall, A Hussein, G Broadwater, D Berry, W P Petros, C Gilbert, M L Affronti, D Coniglio, P Rubin, M Elkordy, G D Long, N J Chao, W P Peters
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 17 Issue 10 Pg. 3064-74 (Oct 1999) ISSN: 0732-183X [Print] United States
• PMID: 10506601 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Estrogen Antagonists
• Tamoxifen
• Doxorubicin
• Fluorouracil
• Methotrexate

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Breast Neoplasms (drug therapy, pathology)
• Combined Modality Therapy
• Doxorubicin (administration & dosage)
• Estrogen Antagonists (administration & dosage)
• Female
• Fluorouracil (administration & dosage)
• Hematopoietic Stem Cell Transplantation
• Humans
• Methotrexate (administration & dosage)
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Survival Analysis
• Tamoxifen (administration & dosage)
• Treatment Outcome