title: Prognostic factors in metastatic breast cancer patients obtaining objective response or disease stabilization after first-line chemotherapy with epirubicin. Evidence for a positive effect of maintenance hormonal therapy on overall survival.
abstract: Randomized trials suggest that the outcome of metastatic breast cancer (BC) patients is not affected by the currently available therapies. Although response rates per se may be associated with survival prolongation, patients experiencing objective response may be those patients fated to have the longest natural disease history. The separation of responders from progressing patients after first-line chemotherapy could allow the selection of a more homogeneous subgroup in which further treatment strategies might achieve a better control of the disease. This study investigated the influence of some patient characteristics, disease characteristics, and previous treatments on the outcome of non progressing patients after first-line chemotherapy with epirubicin administration. We also evaluated the effect of the maintenance endocrine therapy in improving response rate and overall survival (OS). From May 91 to May 93, 207 patients were enrolled in a randomized trial aiming to compare the activity of epirubicin (120 mg/sqm) +/- lonidamine (600 mg/daily). Among the 169 patients attaining complete (CR), partial response (PR) or disease stabilization (SD), 65 were not randomly submitted to maintenance endocrine therapy (MET). Liver involvement, previous adjuvant chemotherapy and previous hormonal therapy (administered in adjuvant setting or for advanced disease) were found to negatively influence OS both in univariate and multivariate analysis. Differences in OS stratifying patients according to DFI, estrogen receptor status and PS did not attain statistical significance. Patients receiving MET survived significantly longer than those submitted to observation and this difference maintained the statistical significance also within patient subsets homogeneous for specific prognostic features. In conclusion, most prognostic factors for advanced BC have been confirmed in our series of patients obtaining CR, PR or SD to full dose epirubicin. The positive prognostic impact of MET is impressive and deserves confirmation in randomized studies.
authors.affiliation: Universitá di Torine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Berruti
authors.forename: P
authors.initials: P
authors.lastname: Zola
authors.forename: T
authors.initials: T
authors.lastname: Buniva
authors.forename: M G
authors.initials: MG
authors.lastname: Baù
authors.forename: A
authors.initials: A
authors.lastname: Farris
authors.forename: M G
authors.initials: MG
authors.lastname: Sarobba
authors.forename: A
authors.initials: A
authors.lastname: Bottini
authors.forename: M
authors.initials: M
authors.lastname: Tampellini
authors.forename: A
authors.initials: A
authors.lastname: Durando
authors.forename: M
authors.initials: M
authors.lastname: Destefanis
authors.forename: C
authors.initials: C
authors.lastname: Monzeglio
authors.forename: G
authors.initials: G
authors.lastname: Moro
authors.forename: M
authors.initials: M
authors.lastname: Sussio
authors.forename: D
authors.initials: D
authors.lastname: Perroni
authors.forename: L
authors.initials: L
authors.lastname: Dogliotti
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D015251:Epirubicin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007191:Indazoles / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D007191:Indazoles; D015251:Epirubicin; C016371:lonidamine