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Adjuvant anthracycline therapy as a prognostic factor in metastatic breast cancer

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Abstract

Background. Prognostic factors in metastatic breast cancer continue to be identified. Previous adjuvant chemotherapy appeared to have poor prognosis in some studies but, despite this, the prior use of anthracyclines in the adjuvant setting has not been clearly established as an adverse prognostic factor once metastatic disease develops.

Patients and methods. Patients (n = 1,436) with stages I–IIIa breast cancer were surgically treated with/without radiotherapy and/or systemic adjuvant treatment. Of these, 297 patients who relapsed with metastatic disease constitute the sample population of this retrospective study. Survival, as a function of time since diagnosis of metastatic disease, was assessed in relation to the following factors: age, size of the primary tumor, grade, number of positive axillary nodes, type of surgery, type of adjuvant treatment administered, time to relapse, number of metastatic sites, presence of visceral metastases and type of treatment employed at the time of relapse.

Results. In multivariable analysis three factors remained significant predictors of short survival time: more than 1 site of metastases (p = 0.00003), shorter time to relapse (p = 0.003) and the previous administration of anthracyclines as adjuvant therapy (p = 0.005).

Conclusions. The prior use of adjuvant anthracyclines, with other known clinical prognostic factors, confers a poorer outcome in metastatic disease, perhaps as a result of resistant clones selection or by induction of de novo resistance.

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References

  1. Early Breast Cancer Trialists' Collaborative Group: Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351: 1451-1467, 1998

    Google Scholar 

  2. Early Breast Cancer Trialists' Collaborative Group: Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet 352: 930-942, 1998

    Google Scholar 

  3. Chlebowsky RT, Weiner JM, Luce J, Hestorff R, Lang JE, Reynolds R, Godfrey T, Ryden VM, Bateman JR. Significance of relapse after adjuvant treatment with combination chemotherapy or 5-fluoruracil alone in high risk breast cancer. Cancer Res 41: 4399-4403, 1981

    Google Scholar 

  4. Dittrich C, Jakesz R, Pirich K, Havelec L, Steger G, Schlappack O, Kolb R, Moser K. Possible adverse effect of failed adjuvant chemotherapy on the prognosis of women receiving consecutive chemotherapy for recurrent breast cancer. J Cancer Res Clin Oncol 113(5): 488-494, 1987

    Google Scholar 

  5. Ahmann FR, Jones SE, Moon TE: The effect of prior adjuvant chemotherapy on survival in metastatic breast cancer. J Surg Oncol 37: 116-122, 1988

    Google Scholar 

  6. Buckner JC, Ingle JN, Everson LK, O'Fallon JR, Cullinan SA, Ahmann DL, Krook JE, Pfeifle DM. Results of salvage hormonal therapy and salvage chemotherapy in women failing adjuvant chemotherapy after mastectomy for breast cancer. Breast Cancer Res Treat 13: 135-142, 1989

    Google Scholar 

  7. Swenerton KD, Legha SS, Smith T, Hortobagyi GN, Gehan EA, Yap HY, Gutterman JV, Blumenschein GR: Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res 39: 1552-1562, 1979

    Google Scholar 

  8. Mick R, Begg CB, Antman KH, Korzun AH, Frei III E: Diverse prognosis in metastatic breast cancer: Who should be offered alternative initial therapy. Breast Cancer Res Treat 13: 33-38, 1989

    Google Scholar 

  9. Chauvin F, Magnet M, Lasset C, Catimel G, Mayer M, Chevarier P, Jacquin JP, Peaud P, Clavel M: Study of prognostic factors in the response of first line chemotherapy in advanced breast cancer. Bull Cancer 77: 941-947, 1990

    Google Scholar 

  10. Vogel C, Azevedo S, Hilsejnbeck S, East DR, Ayoub J: Survival after first recurrence of breast cancer. Cancer 70: 129-135, 1992

    Google Scholar 

  11. Houston SJ, Richards MA, Bentley AE, Smith P, Rubens RD: The influence of adjuvant chemotherapy on outcome after relapse for patients with breast cancer. Eur J Cancer 29: 1511-1518, 1993

    Google Scholar 

  12. Bonneterre J, Mercier M: Response to chemotherapy after relapse in patients with or without previous adjuvant chemotherapy for breast cancer. Cancer Treat Rev 19: 21-30, 1993.

    Google Scholar 

  13. Venturini M, Bruzzi P, Del Mastro L, Garrone O, Bertelli G, Guelfi M, Pastorino S, Rosso R Sertoli MR: Effect of adjuvant chemotherapy with or without anthracyclines on the activity and efficacy of first-line cyclophosphamide, epidoxor ubicin and fluoruracil in patients with metastatic breast cancer. J Clin Oncol 14: 764-773, 1996

    Google Scholar 

  14. Bastholt LL, Dalmark M, Gjedde SB, Pfeifer P, Pedersen D, Sandberg E, Kjaer M, Mouridsen HT, Rose C, Nielsen OS, Jakobsen P, Bentzen SM: Dose response relationship of epirubic in in the treatment of postmenopausal patients with metastatic breast cancer: a randomized study of epirubicin at four different dose levels performed by the Danish Breast Cancer Cooperative Group. J Clin Oncol 14: 1146-1155, 1996

    Google Scholar 

  15. Yamamoto N, Watanabe T, Katsumata N, Omuro Y, Ando M, Fukuda H, Takue Y, Narabayashi M, Adachi I, Takashima S: Construction and validation of a practical prognostic index for patients with metastatic breast cancer. J Clin Oncol 16: 2401-2408, 1998

    Google Scholar 

  16. Buzdar AU, Legha SS, Hortobagyi G, Yap HY, Wiseman CL, Distefano A, Schell FC, Barnes BC, Campos LT, Blumenschein GR. Management of breast cancer patients failing adjuvant chemotherapy with adryamicin-containing regimens. Cancer 47: 2798-2802, 1981

    Google Scholar 

  17. Bitran JD, Desser RK, Shapiro CM, Michel A, Kozloff MF, Billings AA, Recent W. Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy. Cancer 51: 381-384, 1983

    Google Scholar 

  18. Valagussa P, Tancini G, Bonnadona G: Salvage treatment of patients suffering relapse after adjuvant CMF chemotherapy. Cancer 58: 1411-1417, 1986.

    Google Scholar 

  19. Kardinal C, Perry M, Korzun A, Rice MA, Ginsberg S, Wood W: Responses to chemotherapy or chemohormonal therapy in advanced breast cancer patients treated previously with adjuvant chemotherapy. Cancer 61: 415-419, 1988

    Google Scholar 

  20. Stewart DJ, Evans WK, Shepherd F, Wilson KS, Pritchard KI, Trudeau ME, Wilson JJ, Martz K. Cyclophosphamide and fluoruracil combined with mitoxantrone versus doxorubicin for breast cancer: superiority of doxorubicin. J Clin Oncol 15: 1897-1905, 1997

    Google Scholar 

  21. A'Hern RP, Smith IE, Ebbs SR: Chemotherpy and survival in advanced breast cancer: the inclusion of doxorubicin in Cooper type regimens. Br J Cancer 67: 801-805, 1993

    Google Scholar 

  22. Mantel N: Evaluation of survival data in two new rank order statistic arising in its consideration. Cancer Chemother Rep 50: 163-170, 1966

    Google Scholar 

  23. Cox DR: Regression models and life tables. J R Stat Soc B 34: 187-200, 1972

    Google Scholar 

  24. Clark GM, Sledge GW, Osborne CK, McGuire WL: Survival from first recurrence: relative importance of prognostic factors in 1015 breast cancer patients. J Clin Oncol 5: 55-61, 1987

    Google Scholar 

  25. Blanco G, Holli K, Heikkinen M, Kallionemi OP, Taskinen P: Prognostic factors in recurrent breast cancer: relationships to site of recurrence, disease-free interval, female sex, steroid receptors, ploidy and histological malignancy grading. Br J Cancer 62: 142-146, 1990

    Google Scholar 

  26. Hietanen P, Miettinen M, Makinen J.: Survival after first recurrence in breast cancer. Eur J Cancer Clin Oncol 22: 913-919, 1986

    Google Scholar 

  27. Hellman S: The natural history of small breast cancer. David A. Karnofsky Memorial Lecture. J Clin Oncol 12: 2229-2234, 1994

    Google Scholar 

  28. Rizzieri DA, Vredenburgh JJ, Jones R, Ross M, Shpall EJ, Hussein A, Broadwater G, Berry D, Petros WP, Gilbert C, Affranti ML, Coniglio D, Rubin P, Elkordy M, Long GD, Chao NJ, Peters WP: Prognostic and predictive factors for patients with metastatic breast cancer undergoing agressive induction therapy followed by high dose chemotherapy with autologous stem cell support. J Clin Oncol 17: 3064-3074, 1999

    Google Scholar 

  29. Nowell P: The clonal evolution of tumor cell populations. Science 194: 23-28, 1976

    Google Scholar 

  30. Aas T, Borresen AL, Geisler S, Smith-Sorensen B, Johnsen H, Varhaug JE, Akslen LA, Lonning PE. Specific p53 mutations are associated with de novo resistance to doxorubic in in breast cancer patients. Nat Med 2: 811-814, 1996

    Google Scholar 

  31. Lowe SW, Ruley HE, Jacks T, Housman DE: P53-dependent apoptosis modulates the citotoxicity of anticancer agents. Cell 74: 957-967, 1993

    Google Scholar 

  32. Lonn U, Lonn S, Nilsson B, Stenkvist B: Higher frequency of gene amplification in breast cancer patients who received adjuvant chemotherapy. Cancer 77: 107-112, 1996

    Google Scholar 

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Authors and Affiliations

  1. Servicio de Oncología, Hospital Clínico Universitario, Málaga, Spain

    Emilio Alba, Nuria Ribelles, Isabel Sevilla, Antonio Rueda, Lorenzo Alonso, Antonia Marquez, Inmaculada Ruiz & José Miramón

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  1. Emilio Alba
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  2. Nuria Ribelles
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  3. Isabel Sevilla
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  4. Antonio Rueda
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  7. Inmaculada Ruiz
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  8. José Miramón
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Alba, E., Ribelles, N., Sevilla, I. et al. Adjuvant anthracycline therapy as a prognostic factor in metastatic breast cancer. Breast Cancer Res Treat 66, 33–39 (2001). https://doi.org/10.1023/A:1010616532332

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