title: Impact of modern chemotherapy on the survival of women presenting with de novo metastatic breast cancer.
abstract: BACKGROUND
  Data that directly associate utilization of novel systemic therapies with survival trends in metastatic breast cancer (MBC) are limited. In the setting of de novo MBC, large registry analyses cite positive temporal trends in survival, but the extent to which advances in systemic therapy have contributed to these gains is not clear.
  
  
  METHODS
  The City of Hope Cancer Registry was used to identify a consecutive series of patients with de novo MBC who received their first line of therapy between 1985 and 2004. Comprehensive clinicopathologic and treatment-related data were collected for each patient. Univariate analyses were conducted via Cox regression to identify factors associated with improved survival. Multivariate analysis was also conducted via Cox regression and the stepwise procedure was used to identify independent predictors of survival.
  
  
  RESULTS
  A total of 324 patients with de novo MBC were identified. After application of exclusion criteria, including the sole presence of supraclavicular node metastasis, 274 patients were retained in the analysis. The treatment-related characteristics associated with improved survival included: use of endocrine therapy (hazard ratio [HR] 0.60, 95%CI 0.47-0.77; P<0.0001), and addition of bisphosphonates (HR 0.70, 95%CI 0.52-0.96; P=0.02). However, recipients of novel cytotoxic agents (defined as drugs approved for MBC since 1994) had no improvement in survival relative to patients treated with older cytotoxic agents. On multivariate analysis, age (< 50), receipt of aromatase inhibitors, and receipt of zoledronic acid were independent predictors of survival.
  
  
  CONCLUSIONS
  The overall survival of women with de novo metastatic breast cancer has improved over the past 20 years. However, the contribution of conventional cytotoxic agents to this improvement is minimal.
authors.affiliation: Division of Genitourinary Malignancies, Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA. spal@coh.org
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.forename: Mary
authors.initials: M
authors.lastname: Dehaven
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.forename: Susan
authors.initials: S
authors.lastname: Onami
authors.forename: JoAnn
authors.initials: J
authors.lastname: Hsu
authors.forename: Sarah
authors.initials: S
authors.lastname: Waliany
authors.forename: Laura
authors.initials: L
authors.lastname: Kruper
authors.forename: Joanne
authors.initials: J
authors.lastname: Mortimer
mesh_terms: D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome