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11 april 2019: AACR 2019

Wanneer vrouwen die uitgezaaide borstkanker (stadium IV) hebben van het type HER2 positief toch eerst hun borst laten verwijderen middels een operatie en dan laten volgen door systemische behandelingen zoals chemo en / of radiotherapie of gerichte therapie met herceptin - trastuzumab bv of hormoontherapie dan hebben zij grotere kans hun borstkanker te overleven. Dat blijkt uit de resultaten van een postpectieve studie onder 3131 vrouwen met borstkanker stadium IV HER2 positief. Deze studie werd gepresenteerd op de AACR 2019 afgelopen week.

Hier de resultaten uit de presentatie op de AACR van dr. Lum de onderzoeksleidster:

Om het effect van een operatieve verwijdering van de primaire borsttumor (HER2+ stadium IV) te controleren werd een retrospectieve studie uitgevoerd over totaal 3231 vrouwen gebruikmakend van de gegevens uit de  National Cancer Database van 2010 tot 2012. 

Van deze vrouwen had 89.4 procent chemotherapie of gerichte behandelingen gehad (trastuzumab - herceptin meestal), 37.7 procent had hormoontherapie gehad en 31.8 procent radiotherapie - bestraling. Overall, 1,130 vrouwen (35 procent) hadden ook een operatie gehad van de primaire tumor (borst).

Uit de analyse blijkt dat vrouwen die een operatie hadden gehad, meestal naast een vorm van systemische behandelingen, er 44 procent meer overall overleefden in vergelijking met de vrouwen die geen operatie hadden gehad. 

Dit suggereert dat bij vrouwen met uitgezaaide borstkanker stadium IV en HER2 positief dat naast systemische behandelingen een operatie van de borst met de primaire tumor overwogen zou kunnen worden. 

“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.

Wat ook uit de studie kwam was dat blanke mensen met een zorgverzekering eerder in aanmerking kwamen voor een operatie en ook langer en vaker hun borstkanker overleefden. In Amerika zijn veel mensen niet verzekerd en hebben geen geld voor dure behandelingen. Dat zou de studieresultaten wat vertekend kunnen hebben. Maar dr. Lum benadrukt dat de studie dat bij veel vrouwen een operatie vooraf aan systemische behandelingen de kans op overleven zeker verhoogd. 

Ik kan nog geen studierapport vinden. Maar hier de presentatie over deze studie op AACR 2019: Surgery is Associated With Increased Survival for Patients With HER2+ Stage 4 Breast Cancer

Patients without insurance were less likely to receive surgery, increasing disparity in outcomes

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. 

This study was self-funded by the Department of Surgery at Loma Linda University. The authors declare no conflicts of interest.


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