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Section 7
Long-term Survival with Metastatic Breast Cancer

PROLONGED COMPLETE REMISSION

I believe that you can palliate patients with metastatic breast cancer very effectively with the current available treatments, and I have no question that you can prolong survival. I also believe that you can cure some patients with metastatic breast cancer. It’s a very small percentage, but you can do it. My group has published about patients who have achieved a complete remission with chemotherapy and are in a progression-free complete remission 20 years later — biopsy proven.

Many of us have relevant anecdotal situations. For instance, I have a patient who had a lung metastasis resected in 1968, and she never received any additional therapy. She never had a second metastasis — metastatic breast cancer by definition, pathology proven, and she’s alive and well — 32 years of disease-free survival. Is that sufficient to call her cured? I don ’t know. But it’s certainly a major therapeutic advantage.

When speaking with patients, I do not use the word “cure ” in the metastatic setting. I say that for the great majority, our realistic expectation from existing treatments today is to stop the progression of disease and perhaps reduce tumor burden for some period of time. We can also control symptoms in the majority of patients — at least for some time — and there is a very small minority in whom we can achieve a complete remission. I also say that some patients remain without a recurrence for very long time periods — and I tell patients the numbers. In our experience, in untreated patients, it’s about three percent.

—Gabriel Hortobagyi, MD

NEW CYTOTOXIC AGENT IN CLINICAL TRIALS

The epothilones are very exciting. We are now evaluating the prototype in a phase II study, but the preclinical and phase I data look very encouraging. It’s a tubulin active agent that also stabilizes microtubular formation. It is clearly effective in Taxol-resistant tumor cells. There’s actually a family of them, but this one is semi-synthetic and is much more stable than the native compound.

Certainly, chemotherapy as we know it today has provided some advantages and some benefits, but I think we will continue to find novel agents that will build — perhaps step-wise — on what we have. There’s a whole new group of cytotoxic agents available — designed on the basis of structure-function interactions. We have already started to replace some of the older agents with newer ones. I don’t remember the last time I used mitomycin C for instance; I have not used Velban® (vinblastine) now for several years, and I have seldom used methotrexate over the last four or five years. With capecitabine being available, it’s very likely that 5-FU will sort of disappear or fade away.

—Gabriel Hortobagyi, MD

SELECT PUBLICATIONS

Chou TC et al. Desoxyepothilone B is curative against human tumor xenografts that are refractory to paclitaxel. Proc Natl Acad Sci U S A 1998;95(26):15798-802. Full Text

Greenberg PA et al. Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol 1996;14(8):2197-205. Abstract

Lee FY et al. BMS-247550: A novel epothilone analog with a mode of action similar to paclitaxel but possessing superior antitumor efficacy. Clin Cancer Res 2001;7(5):1429-37. Abstract

 

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Editor’s Note

Neoadjuvant endocrine therapy

Is four cycles of AC adequate adjuvant therapy?

Taxanes in the adjuvant and metastatic setting

Aromatase inhibitors in clinical practice

Combination endocrine therapy

Tamoxifen and quality of life

Long-term survival with metastatic breast cancer

Capecitabine for metastatic disease

Menopause and hormone replacement in breast cancer patients

Pregnancy after breast cancer treatment

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