Men with stage IV breast cancer who are receptive to systemic therapy benefit from surgery
Men with stage IV breast cancer and known estrogen (ER) and progesterone (RA) receptor status benefit from surgery and trimodal therapy (systemic therapy, surgery and radiotherapy), according to a study presented at the Virtual American College of Surgeons (ACS) Clinical Congress 2021.
The National Comprehensive Cancer Network’s guidelines for treating men with stage IV breast cancer recommend systemic treatment, with surgery to be used to minimize symptoms such as ulcerations, pain or bleeding, said the first author Kelly A. Stahl, MD, resident in surgery at Penn State College of Medicine, Hershey. However, new studies show that surgery has survival benefits for men with stage IV breast cancer, she said.
We need to re-examine the idea that stage IV breast cancer in men is so severe that there is no survival benefit from surgery. “
Daleela G. Dodge, MD, FACS, general surgeon, Penn State Health Milton S. Hershey Medical Center in Hershey, PA, and study co-author
“For this subset of patients who respond to systemic treatment and do not have a lot of metastatic burden, we would like there to be a review of best practices.”
Breast cancer in men accounts for less than 1% of all breast cancer cases, while one in eight women gets breast cancer compared to one in 1,000 men, Dr Dodge said. As a result, public awareness of breast cancer in men is low.
“We have devoted a whole month to raising awareness of breast cancer in women, but it is not entirely clear that men can get it too, and that some men even have a genetic predisposition to get it,” he said. said Dr Stahl.
Unfortunately, low public awareness has contributed to the fact that 6 percent of women versus 10 percent of men are not diagnosed until they have stage IV cancer. In addition, 40 percent of male breast cancer patients are not diagnosed until stage III or IV, although it is easier for male patients to detect breast cancer on their own, said Dr. Dodge. She added: “Men have a worse prognosis due to late diagnosis, so awareness is important.”
About the study
The authors were surprised at how many patients they could find that matched their study parameters, crediting the large dataset from the National Cancer Database (NCDB). Researchers identified 539 stage IV breast cancer patients with known ER / PR status from 2004 to 2017 in NCDB. Chi-square tests examined subgroup differences between the treatment modalities received. Overall survival was assessed using the Kaplan-Meier method. Cox multivariate proportional hazards models examined factors associated with survival.
A noted survival advantage
The researchers found a noted survival advantage in patients who received trimodal therapy compared to patients who received systemic therapy alone. ER-positive patients who received trimodal therapy or systemic therapy and surgery had an improved 5-year overall survival rate compared to systemic therapy. RA positive patients who received trimodal therapy or systemic therapy and surgery had an improved 5-year overall survival rate compared to systemic therapy. The treatment sequence was significant, with the greatest survival benefit noted in ER positive patients who received neoadjuvant chemotherapy compared to those who received adjuvant chemotherapy.
“We are trying to catch up to better tailor our treatment for men with breast cancer and this study shows how treatment can be tailored for stage IV of the disease,” said Dr Dodge.
American College of Surgeons