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Cnossen, Jitske (2011): Overall survival in metastatic breast cancer patients: a single-centre analysis (2000-2005). Dissertation, LMU München: Medizinische Fakultät



Background: Recent epidemiological studies suggest that chemotherapy has not contributed to a marked improvement of patient outcome during the last decades. In most randomized trials which investigated the efficacy of a 1st-line schedule for metastatic breast cancer (MBC), the median survival ranged between 18 and 24 months. The goal of the present study was to analyse the survival of patients with MBC treated in a single university outpatient clinic. Methods: Patients who had received their complete anti-cancer treatment for MBC in our outpatient clinic between 2000 and 2005 were analyzed for treatment and survival. Results: 232 patients [median age of 53, range 27-87 yrs; ER and/or PgR positive (HR+) n=174 (75%); HER2 over-expression (HER2+) n=79 (34%)] were included in the analysis. Endocrine sensitive patients received 1-2 (58.6%), 3-4 (37.4%) and 5-6 (2.3%) hormonal regimens. Of all patients 53.4% received up to 3 cytostatic agents in palliative intent, 4-6 regimens were applied in 22.1% and 12.9% received more than 6 subsequent regimens during the course of their disease. The median overall survival (OS) from time of diagnosis of metastatic disease was 44 months. Patients with HR positive tumours survived 46 months, whereas the survival of those with HR negative tumours was 34 months (p=0.07). HER2+ patients who received trastuzumab survived for a median of 44 months. Visceral involvement was associated with a shorter survival as compared to non-visceral disease (34 vs. 57 months, p<0.05). Thirty-one patients underwent loco-regional procedures as resection of metastases (n=14, 6.0%) or radiofrequency ablation (n=17, 7.3%). Conclusion: These data show a selective patient population in a single-centre setting, that report improved survival rates. Whether innovative medicine, a step by step escalation of all treatment modalities according to standard guidelines and individualized clinical requirements and a multidisciplinary treatment approach contribute to these good outcomes is debatable. Key words: metastatic breast cancer, survival, chemotherapy, endocrine therapy, therapy sequences