Treatment of Overt Metastatic Disease

Abstract

Almost 90% of the patients are diagnosed as having operable disease. The term operable refers to the fact that the disease is confined to the mammary gland and to the ipsilateral axilla. The majority of this population will relapse, commonly in regions which are distant from the first site of the tumour. Data available after a long-term follow-up (of 31 years) show that metastatic disease may appear at any time after a successful treatment of the primary tumour. Overt metastatic disease must, with very few exceptions, be considered an incurable condition. The patient who relapses will eventually die with or of metastatic breast cancer. The majority of the patients who relapse will require palliation of symptoms of metastatic disease, and at such time the attitude toward the patient should take into account some quality-of-life considerations. Ideally the therapy for metastatic disease with the available treatments should obtain the maximal relief of symptoms (possibly even start therapy just before their onset), for the maximal duration with the minimal burden of side effects. The decision to treat and the choice of treatment must therefore take into account the extent of the disease and the related symptoms, not only those which are present but also those likely to occur within a short period of time. The objective is to increase the total duration of time with no or few disease-related symptoms. The choice of treatment must also take into consideration certain biological features which define the aggressiveness of the disease:

• ◻ shorter disease-free interval (the time period between the first surgery and the onset of overt metastatic disease);

• ◻ multiple organ involvement ( bone, liver, lung, subcutaneous tissue are each to be considered as one organ involvement); the extent of damage to the organ involved is very important: jaundice or thrombocytopenia due to massive liver or bone marrow metastases, respectively, are indications of a dire prognosis;

• ◻ low or no steroid hormone receptors in the tumour tissue (because of greater chance of longer responses obtainable with hormonal manipulation); these are the most important factors in defining a significantly shorter survival.