Survival of metastatic breast cancer (MBC): Is there a survival benefit over time?

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e21062 Background: Whether survival of patients with MBC is improved over time remains controversial. Randomised clinical trials demonstrated if at all a small benefit between different therapies and a meaningfull translation into clinical practice is doubtfull. Methods: Excluding patients with local recurrence only, we analysed 839 patients, treated at our institution from 1985-2009, according to date of primary diagnosis or date of first metastasis. The influence of hormonal receptor status (HR+, HR-), metastasis free interval (MFI) (< 24 months up to >60 months) and diagnosis before and after 1996 (introduction of taxanes and aromatase inhibitors) was examined. Results: Improvement of survival was observed, when the primary tumor was diagnosed later (intervalls of 1985-1989, 1990-1994, 1995-1999, 2000-2004, 2005-2009) (p= 0,006) however, no survival effect was observed according to date of metastasis (p= 0,11). Median survival of patients with HR+ was 32.1 vs. 17.0 months for in HR- (p< 0,0001). A shorter metastasis free intervall was associated with a shorter OS (MFI < 24 months: 22.0 mo, MFI 24-60 months:31.1 mo, MFI > 60 months: 36.0 mo) (p< 0,0001). HR+ patients survived longer when metastasis occurred in a later period (5 year intervals between 1985-1999 median ~ 32.0 months vs. 2000-2004 median ~38 months) (p=0,02). No significance for HR- patients. No survival difference before or after 1996 was observed for the total cohort (median 27.1 vs. 30.0 months) (p=0,58), HR+ patients (p= 0,92) or HR- patients (p=0,93) and also not for patients with metastasis free interval < 24 months (19.1 vs. 22.0 months) (p=0,86). Conclusions: A survival difference is only seen for HR+ patients with metastasis diagnosed after 2000. An influence of taxanes in aggressive disease (metastasis free interval < 24 months) is unlikely. Whether aromatase inhibitors have an influence on survival for the overall cohort (HR+ and HR-) is unclear, but may explain the survival benefit seen in HR+ patients. The tumor biology has probably a greater impact on survival in MBC than any new antineoplastic agent.

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