Surgery associated with increased survival for patients with HER2+ stage 4 breast cancer

April 02, 2019

ATLANTA -- Surgery was associated with higher survival rates for patients with HER2-positive (HER2+) stage 4 breast cancer compared with those who did not undergo surgery, according to results presented at the AACR Annual Meeting 2019, March 29-April 3.

Between 20 and 30 percent of all newly diagnosed stage 4 breast cancer cases are HER2+, explained the study's lead author, Ross Mudgway, a medical student at the University of California, Riverside School of Medicine. This form of breast cancer once had poor outcomes, but in recent years, advances in targeted therapy, such as trastuzumab (Herceptin), have led to improved survival.

In recent years, most patients with HER2+ breast cancer have been treated with systemic therapy, which could include chemotherapy, targeted therapy, or hormonal therapy, Mudgway said. Surgery is sometimes offered to these patients, but previous research on whether surgery improves survival has yielded mixed results, he said.

Mudgway and senior author Sharon Lum, MD, professor in the Department of Surgery-Division of Surgical Oncology and medical director of the Breast Health Center, Loma Linda University Health, noted that HER2 status has been reported in large registry data sets since the early 2000s, but the impact of surgery on this type of breast cancer has not been well documented across hospital systems. To assess the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients, they conducted a retrospective cohort study of 3,231 women with the disease, using records from the National Cancer Database from 2010 to 2012.

Of these women, 89.4 percent had received chemotherapy or targeted therapies, 37.7 percent had received endocrine therapy, and 31.8 percent had received radiation. Overall, 1,130 women, or 35 percent, received surgery.

The researchers found that surgery was associated with a 44 percent increased chance of survival, assuming the majority also had systemic treatment.

"This suggests that, in addition to standard HER2 targeted medications and other adjuvant therapy, if a woman has stage 4 HER2+ breast cancer, surgery to remove the primary breast tumor should be considered," said Lum.

The study also examined factors associated with receipt of surgery and found that women with Medicare or private insurance were more likely to have surgery and less likely to die of their disease than those with Medicaid or no insurance. White women were also more likely than non-Hispanic black women to have surgery and less likely to die of their cancer.

"These results suggest disparities in health care due to race and socioeconomic factors, and these must be addressed," Mudgway said.

Mudgway and Lum said numerous factors may contribute to a physician's decision on whether to recommend surgery, including comorbidities, response to other forms of treatment, and overall life expectancy. They said these findings should be considered in the context of all other factors.

"For patients, the decision to undergo breast surgery, especially a mastectomy, can often be life-changing as it affects both physical and emotional health," Mudgway said. "The patient's own feelings about whether or not she wishes to have surgery should be considered."

Lum noted that this is a retrospective study and may not be fully representative of women facing the decision of whether to have surgery. For example, she noted, doctors may be most willing to operate on women who are healthier overall and are, therefore, more likely to experience a positive outcome. Further research would be needed to confirm the survival benefit suggested by this study.
-end-
This study was self-funded by the Department of Surgery at Loma Linda University. The authors declare no conflicts of interest.

American Association for Cancer Research

Related Breast Cancer Articles from Brightsurf:

Oncotarget: IGF2 expression in breast cancer tumors and in breast cancer cells
The Oncotarget authors propose that methylation of DVDMR represents a novel epigenetic biomarker that determines the levels of IGF2 protein expression in breast cancer.

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.

Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.

More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.

Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.

Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.

Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.

Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.

Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.

Read More: Breast Cancer News and Breast Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.