Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar 15;119(6):1140-8.
doi: 10.1002/cncr.27819. Epub 2012 Oct 12.

Survival in patients with metastatic recurrent breast cancer after adjuvant chemotherapy: little evidence of improvement over the past 30 years

Amye J Tevaarwerk  1 , Robert J Gray, Bryan P Schneider, Mary Lou Smith, Lynne I Wagner, John H Fetting, Nancy Davidson, Lori J Goldstein, Kathy D Miller, Joseph A Sparano
Affiliations

Survival in patients with metastatic recurrent breast cancer after adjuvant chemotherapy: little evidence of improvement over the past 30 years

Amye J Tevaarwerk et al. Cancer. .

Abstract

Background: Population-based studies have shown improved survival for patients diagnosed with metastatic breast cancer over time, presumably because of the availability of new and more effective therapies. The objective of the current study was to determine whether survival improved for patients who developed distant recurrence of breast cancer after receiving adjuvant therapy.

Methods: Adjuvant chemotherapy trials coordinated by the Eastern Cooperative Oncology Group that accrued patients between 1978 and 2002 were reviewed. Survival after distant disease recurrence was estimated for progressive time periods, and adjusted for baseline covariates in a Cox proportional hazards model.

Results: Of the 13,785 patients who received adjuvant chemotherapy in 11 trials, 3447 (25%) developed distant disease recurrence; the median survival after recurrence was 20 months (95% confidence interval, 19 months-21 months). Factors associated with inferior survival included a shorter distant recurrence-free interval (DRFI), estrogen receptor-negative and progesterone receptor-negative disease, the number of positive axillary lymph nodes present at the time of diagnosis, and black race (P < .0001 for all). When the time period of recurrence was added to the model, it was not found to be significantly associated with survival for the general population with disease recurrence. Survival improved over time only in those patients with hormone receptor-negative disease with a DRFI ≤ 3 years, both among the 5 most recent and the entire trial data sets (P = .01 and P = .05, respectively).

Conclusions: In contrast to reports from population-based studies, no general improvement in survival was observed over the last 30 years for patients who developed distant disease recurrence after adjuvant chemotherapy after adjusting for DRFI. Improved survival for patients with hormone receptor-negative disease with a short DRFI suggests a benefit from trastuzumab.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Figure 1a. All Eleven Trials: Survival after distant recurrence Figure 1b. All Eleven Trials: Survival following recurrence by DRFI (p<0.0001) Figure 1c. Five Recent Trials: Survival following recurrence by DRFI (p<0.0001)
Figure 1
Figure 1
Figure 1a. All Eleven Trials: Survival after distant recurrence Figure 1b. All Eleven Trials: Survival following recurrence by DRFI (p<0.0001) Figure 1c. Five Recent Trials: Survival following recurrence by DRFI (p<0.0001)
Figure 1
Figure 1
Figure 1a. All Eleven Trials: Survival after distant recurrence Figure 1b. All Eleven Trials: Survival following recurrence by DRFI (p<0.0001) Figure 1c. Five Recent Trials: Survival following recurrence by DRFI (p<0.0001)
Figure 2
Figure 2
Figure 2a: All Eleven Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 2b. All Eleven Trials: Survival following recurrence by time period of recurrence in patients WITH DRFI≤ 3 Years (p=0.04) Figure 2c. All Eleven Trials: Survival following recurrence by time period in patients WITH DRFI> 3 Years (p=0.47)
Figure 2
Figure 2
Figure 2a: All Eleven Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 2b. All Eleven Trials: Survival following recurrence by time period of recurrence in patients WITH DRFI≤ 3 Years (p=0.04) Figure 2c. All Eleven Trials: Survival following recurrence by time period in patients WITH DRFI> 3 Years (p=0.47)
Figure 2
Figure 2
Figure 2a: All Eleven Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 2b. All Eleven Trials: Survival following recurrence by time period of recurrence in patients WITH DRFI≤ 3 Years (p=0.04) Figure 2c. All Eleven Trials: Survival following recurrence by time period in patients WITH DRFI> 3 Years (p=0.47)
Figure 3
Figure 3
Figure 3a. All Eleven Trials: Survival following recurrence by time period for hormone-receptor positive patients with DRFI≤ 3 Years (p=0.41) Figure 3b. All Eleven Trials: Survival after recurrence by time period in hormone-receptor negative patients with DRFI≤ 3 Years (p=0.05) Figure 3c. All Eleven Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years. (p=0.94) Figure 3d. Five Recent Trials: Survival following distant recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.46)
Figure 3
Figure 3
Figure 3a. All Eleven Trials: Survival following recurrence by time period for hormone-receptor positive patients with DRFI≤ 3 Years (p=0.41) Figure 3b. All Eleven Trials: Survival after recurrence by time period in hormone-receptor negative patients with DRFI≤ 3 Years (p=0.05) Figure 3c. All Eleven Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years. (p=0.94) Figure 3d. Five Recent Trials: Survival following distant recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.46)
Figure 3
Figure 3
Figure 3a. All Eleven Trials: Survival following recurrence by time period for hormone-receptor positive patients with DRFI≤ 3 Years (p=0.41) Figure 3b. All Eleven Trials: Survival after recurrence by time period in hormone-receptor negative patients with DRFI≤ 3 Years (p=0.05) Figure 3c. All Eleven Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years. (p=0.94) Figure 3d. Five Recent Trials: Survival following distant recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.46)
Figure 3
Figure 3
Figure 3a. All Eleven Trials: Survival following recurrence by time period for hormone-receptor positive patients with DRFI≤ 3 Years (p=0.41) Figure 3b. All Eleven Trials: Survival after recurrence by time period in hormone-receptor negative patients with DRFI≤ 3 Years (p=0.05) Figure 3c. All Eleven Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years. (p=0.94) Figure 3d. Five Recent Trials: Survival following distant recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.46)
Figure 4
Figure 4
Figure 4a. Five Recent Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 4b. Five Recent Trials: Survival following recurrence by time period of distant recurrence in hormone-receptor positive patients with DRFI≤ 3 Years (p=0.22) Figure 4c. Five Recent Trials: Survival following recurrence by time period hormone-receptor negative patients with DRFI≤ 3 Years (p=0.01) Figure 4d. Five Recent Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years (p=0.64) Figure 4e. Five Recent Trials: Survival after recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.57)
Figure 4
Figure 4
Figure 4a. Five Recent Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 4b. Five Recent Trials: Survival following recurrence by time period of distant recurrence in hormone-receptor positive patients with DRFI≤ 3 Years (p=0.22) Figure 4c. Five Recent Trials: Survival following recurrence by time period hormone-receptor negative patients with DRFI≤ 3 Years (p=0.01) Figure 4d. Five Recent Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years (p=0.64) Figure 4e. Five Recent Trials: Survival after recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.57)
Figure 4
Figure 4
Figure 4a. Five Recent Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 4b. Five Recent Trials: Survival following recurrence by time period of distant recurrence in hormone-receptor positive patients with DRFI≤ 3 Years (p=0.22) Figure 4c. Five Recent Trials: Survival following recurrence by time period hormone-receptor negative patients with DRFI≤ 3 Years (p=0.01) Figure 4d. Five Recent Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years (p=0.64) Figure 4e. Five Recent Trials: Survival after recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.57)
Figure 4
Figure 4
Figure 4a. Five Recent Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 4b. Five Recent Trials: Survival following recurrence by time period of distant recurrence in hormone-receptor positive patients with DRFI≤ 3 Years (p=0.22) Figure 4c. Five Recent Trials: Survival following recurrence by time period hormone-receptor negative patients with DRFI≤ 3 Years (p=0.01) Figure 4d. Five Recent Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years (p=0.64) Figure 4e. Five Recent Trials: Survival after recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.57)
Figure 4
Figure 4
Figure 4a. Five Recent Trials: Survival following distant recurrence by time period WITHOUT adjustment for DRFI (p<0.0001, logrank test without stratification) Figure 4b. Five Recent Trials: Survival following recurrence by time period of distant recurrence in hormone-receptor positive patients with DRFI≤ 3 Years (p=0.22) Figure 4c. Five Recent Trials: Survival following recurrence by time period hormone-receptor negative patients with DRFI≤ 3 Years (p=0.01) Figure 4d. Five Recent Trials: Survival following recurrence by time period in hormone-receptor negative patients with DRFI > 3 Years (p=0.64) Figure 4e. Five Recent Trials: Survival after recurrence by time period in hormone-receptor positive patients with DRFI > 3 Years (p=0.57)
See this image and copyright information in PMC

References

    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. - PubMed
    1. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353(17):1784–92. - PubMed
    1. Dawood S, Broglio K, Ensor J, Hortobagyi GN, Giordano SH. Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 1(11):2169–74. - PMC - PubMed
    1. Giordano SH, Buzdar AU, Smith TL, Kau SW, Yang Y, Hortobagyi GN. Is breast cancer survival improving? Cancer. 2004;100(1):44–52. - PubMed
    1. Chia SK, Speers CH, D’Yachkova Y, et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer. 2007;110(5):973–9. - PubMed

Publication types