Surgically removing the primary tumor in women with stage IV breast cancer before they undergo standard therapies extends their lives compared to the latter alone, according to a international clinical trial conducted by the University of Pittsburgh Cancer Institute.
"We believe that in general metastatic [breast cancer] survival is better than yesterday with the developments of diagnostic tools and systemic therapies, and there is a role for surgery of the primary tumor in patients with stage IV breast cancer at presentation," Dr. Atilla Soran, principal investigator and clinical professor of surgery at the university, told HCB News.
The trial was initiated in 2007 and it ended up recruiting 274 women with newly diagnosed stage IV breast cancer from 25 institutions.
Half of the women received standard therapy, which involved a combination of chemotherapy, hormonal therapy and targeted therapy. The other half first underwent surgery to remove their primary tumor and then were treated with standard therapy.
About 40 months after the women were diagnosed, those who underwent surgery plus standard therapy lived an average of nine months longer than those who received only standard therapy.
In addition, almost 42 percent of the women who had surgery lived to five years after diagnosis, but less than 25 percent of women who did not receive surgery lived that long.
The trial also revealed that younger women with less aggressive cancers who underwent surgery survived longer than women with more aggressive cancers that spread to the liver or lungs.
When a personal approach is taken — one that considers the patient's performance status, age, comorbidities and the burden of metastatic disease — the combination of surgery and systemic therapy can yield almost 20 percent more 5-year survival benefit, according to Soran.
Soran described this approach as a battle against two enemies — first you quickly defeat one army (the primary tumor) with surgery and then you concentrate your efforts on battling the second army (the remaining cancer) with standard therapy.
The results of this phase III randomized, controlled trial will be presented this weekend at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
