Role of surgery for the treatment of Metastatic Breast Cancer

According to a study, “the importance of surgery together with the systemic treatments or with systemic treatments and radiation therapy can improve survival for women diagnosed with metastatic HER2+ breast cancer. The facts and figures were released on October 30’th, 2020, by the leading journals in Oncology and Surgery named Annals of Surgical Oncology. 

The metastatic breast cancer also can be addressed as stage IV breast cancer, that has spread to other organs of the body away from the breast, be it bones, be it liver or any other organs. 

Moving on to systemic treatments, then this treatment is a kind of treatment that mainly affects the entire body by going through the bloodstream. Instances of the systemic treatment include chemo drugs, hormonal therapy drugs, targeted therapy drugs, and immunotherapy drugs.

Studies suggest that the surgery is able to enhance the survival for patients diagnosed with metastatic breast cancer, but mixed outcomes have been noted. Still, absence of earlier data took into account the hormone receptor status or the HER2 status of breast cancer or whether considering chemo prior to or following surgery affected survival. So the certain researchers wanted to carry out another study considering those 3 factors into account.

According to Kelly Stahl, M.D., lead author and surgical resident at the Penn State College of Medicine, delivered words in a statement, “Outcomes noted from previous trials suggest that the surgical factors in patients with the metastatic breast cancer have been questioned due to countable participants or the terms that patients weren’t also taking chemo or any other systemic therapies.”

“We sensed another crucial factor absent from those carried out studies was whether the biologic subtype of disease affected the SR in relation to the surgical intervention,” Kelly added. 

The carried out study was a retrospective study, meaning the existing researchers looked at data collected in the past, prior to the study was carried out.

In this study that was carried out between 2010 and 2015, total 12,838 women with metastatic breast cancer have participated. All the data came from the database of National Cancer, a bulk information on approximately 70% of newly diagnosed cancer cases managed by the American Cancer Society and the American College of Surgeons. The entire information comes from approximately 1,500 Commission on Cancer accredited programs.

All the enrolled women lived over 6 months following being diagnosed with metastatic breast cancer, and all the candidates received the systemic treatment.

In carried out study, 6,649 were given the systemic treatment alone, 2,906 were given systemic treatment together with radiation therapy, 1,689 were given systemic treatment together with surgery, and 1,594 were given systemic treatment, surgery, as well as the radiation therapy. 

The researchers noted the 5-year overall survival rates of the multiple treatment groups. The researchers ended up with that the women who were treated with surgery had comparatively better survival rates in comparison to those women who were not treated with surgery.

The 5-year overall survival rates were: 38% for women who were given systemic treatment, surgery, and radiation therapy, 32% for women who were given systemic treatment with the surgery, 21% for women who were given systemic treatment alone, and 19% for women who were given systemic treatment as well as radiation therapy. 

For the 931 women with metastatic HER2+ breast cancer, women who were treated with surgery had the better survival in comparison to those women who were not treated with surgery.

5ive-year overall survival rates for women with HER2+ breast cancer were: 48% for women who were given systemic treatment, surgery, as well as radiation therapy, 41% for women who were given systemic treatment as well as surgery, 29% for women who were given the systemic treatment alone, 21% for women who were given systemic treatment as well as radiation therapy. 

The researchers observed that the OS rates for women with metastatic HER2+ breast cancer were greater than they were for all the women in the study, literally no matter the treatment regimen they were given.

For the enrolled 3,283 participants with surgery, the researchers noted in case the timing of the chemo in relation to the surgery affected the survival rates, considering the HR status and HER2 status.

For participants with HER2+ metastatic breast cancer, chemo prior to surgery, named neoadjuvant chemo by doctors, was linked to good survival in comparison to chemo after surgery, named adjuvant chemo by doctors. 5-year OS rates for women with HER2+ metastatic breast cancer were: 55% for women who were given neoadjuvant chemo, 35% for women who were given adjuvant chemo. 

For participants with HER2+ metastatic breast cancer, neoadjuvant chemo also was linked to great survival.

5-year overall survival rates were: 42% for women with HER2+ disease were given neoadjuvant chemo, 30% for women with HER2+ disease were given adjuvant chemo, 45% for women with estrogen ve+ disease were given neoadjuvant chemo, 32% for women with progesterone-receptor ve+ disease were given adjuvant chemotherapy. 

According to Chan Shen, Ph.D., associate professor of surgery at Penn State, “Not only did we got that surgery can be beneficial for the treatment responsive metastatic breast cancer patients, we also uncovered that getting chemo prior to surgery had the better survival benefits in patients with HER2+ and estrogen and progesterone receptor status.” 

While the outcomes of this study are quite encouraging, it’s necessary to consider that the carried out study was a retrospective study, so the entire data was collected prior to the study being carried out.

Several researchers think that a retrospective study is not as much impactful as a prospective study, where the study is planned and then the entire data is collected.

Still, if in case you’re with metastatic breast cancer, especially HER2+ or HR+ breast cancer, and surgery isn’t apt for you, you may want to consider this study and interact with your healthcare practitioner in order to know why surgery isn’t apt for you. In case you do decide in order to have surgery, you can also talk to your healthcare practitioner in order to know the timing of chemo.

This study suggests that considering chemo prior to surgery for metastatic HER2+ or HR+ disease or breast cancer offers great survival advantages in comparison to having chemo following surgery.

Reference:

https://www.breastcancer.org/research-news/surgery-plus-standard-tx-for-certain-types-of-mbc#about