Prognosis for patients with metastatic breast cancer who achieve a no-evidence-of-disease status after systemic or local therapy.
BACKGROUND
This study sought to determine outcomes for patients with metastatic breast cancer (MBC) with no evidence of disease (NED) after treatment and to identify factors predictive of outcomes once the status of NED was attained.


METHODS
This study reviewed 570 patients with MBC who were consecutively treated between January 2003 and December 2005. Ninety patients (16%) attained NED, which was defined as a complete metabolic response on positron emission tomography or sclerotic healing of bone metastases on computed tomography or magnetic resonance imaging. The median follow-up for patients attaining NED was 100 months (range, 14-134 months).


RESULTS
The 3- and 5-year overall survival (OS) rates were 44% and 24%, respectively, for the entire group and 96% and 78%, respectively, for those attaining NED. According to a landmark analysis, NED status was significantly associated with survival at 2 (P < .001; hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.16-0.34) and 3 years (P < .001; HR, 0.20; 95% CI, 0.14-0.30). From the time of NED, the median survival was 102 months (range, 14-134 months) with 5-year OS and progression-free survival (PFS) rates of 77% and 40%, respectively. According to a multivariate analysis, human epidermal growth factor receptor 2 positivity was significantly associated with OS in comparison with estrogen receptor positivity (P = .02; HR, 0.44; 95% CI, 0.21-0.90), and trastuzumab use was significantly associated with PFS (P = .007; HR, 0.48; 95% CI, 0.28-0.82). Thirty-one patients (34%) with NED remained in remission at the last follow-up.


CONCLUSIONS
MBC patients who attain the status of NED have significantly prolonged survival with a durable response to therapy. Ultimately, this study provides essential outcome data for clinicians and patients living with MBC.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Andrew J
AJ
Bishop
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Joe
J
Ensor
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Stacy L
SL
Moulder
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Simona F
SF
Shaitelman
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Mark A
MA
Edson
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gary J
GJ
Whitman
Department of Electrical and Computer Engineering, Rice University, Houston, Texas.
Sandra
S
Bishnoi
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Karen E
KE
Hoffman
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Michael C
MC
Stauder
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Vicente
V
Valero
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Thomas A
TA
Buchholz
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Naoto T
NT
Ueno
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gildy
G
Babiera
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Wendy A
WA
Woodward
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D012074:Remission Induction; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D000068878:Trastuzumab
breast cancer; complete response; metastatic; no evidence of disease (NED); survival; targeted therapy