New research found that early, primary-site locoregional therapy does not improve survival among individuals with de novo stage-IV breast cancer, from Journal of Clinical Oncology. 

Interestingly, the trial (NCT01242800) concluded that while such therapy correlated with improved locoregional control of metastatic disease, it showed no overall impact on patient quality of life. 

To help address previous inconsistent findings, they enrolled 390 patients, all of whom presented with metastatic breast cancer and an intact primary tumor and randomly assigned 256 patients to either continuation of systemic therapy (n = 131) or early locoregional therapy (n = 125). 

Participants received systemic therapy for 4-8 months. If no disease progression was observed in that period, patients were randomly assigned to one of two therapeutic regimens: either continuation of systemic therapy or locoregional therapy for the primary site.  

Those undergoing locoregional therapy had surgery and radiotherapy according to standards for non-metastatic disease.  

Researchers found 3-year overall survival was 67.9% in patients who continued systemic therapy, compared with 68.4% in the early locoregional therapy group (HR = 1.11; 90% CI; 0.82-1.52; P = .57).  

Median OS was also statistically comparable between groups: 53.1 months (95% CI; 47.9 to not estimable) among patients in the systemic therapy arm and 54.9 months (95% CI; 46.7 to not estimable) in the group on locoregional therapy.  

The only statistically significant difference observed between groups was with respect to 3-year locoregional progression, which they found less frequently in those assigned locoregional therapy (16.3%) than in those on continued systemic therapy (39.8%; P < .001).  

Following a period of initial systemic therapy that either stabilized or decreased distant disease burden—early locoregional therapy seems to offer no OS benefit among patients with metastatic breast cancer relative to those treated with continued systemic therapy, Khan and colleagues concluded. 

“Locoregional therapy for the primary breast tumor should not be recommended to patients with an asymptomatic primary tumor and distant metastases, with the expectation of improved survival. If such a treatment is contemplated to decrease the risk of future local progression, the lack of evidence for improved quality of life should also be discussed,” Khan and colleagues wrote. 

Disclosures: Some authors declared financial ties to drugmakers. See full study for details.  
Reference: 
https://ascopubs.org/doi/full/10.1200/JCO.21.02006 

Images: Getty Images, Pixabay 

By Michael Vlessides, MD /alert Contributor