In Austria, around 250 women a year are told they are suffering from primary "metastatic breast cancer". That means: breast cancer is first diagnosed at a late stage. Despite recent advances in treatment, a "cure" is not possible in these fortunately rare situations; the therapeutic aims are to maintain quality-of-life and extend life expectancy – many women go on to survive for several years. Breast cancer experts from throughout the world are therefore working to improve treatment strategies and, at the same time, the quality-of-life of their patients.
A research team from the ABCSG (President: Michael Gnant, MedUni Vienna/Vienna General Hospital), headed up by Florian Fitzal, therefore explored whether immediate surgical removal of the breast cancer tissue prior to administration of systemic (drug) therapy influences the treatment outcome. During the last decade, this method was regarded as a possible strategy for treating primary metastatic breast cancer. The scientific basis for this procedure was retrospective studies, that is to say studies that analyse pre-existing data, and these showed that surgery could potentially prolong survival by up to 50%.
The results of the ABCSG-28 trial now show that surgery prior to systemic therapy does not improve the outcome over primary systemic therapy. These results tally with the findings of other international studies that have recently appeared.
Says Fitzal: "Our work shows that an operation does not offer patients any advantage in terms of survival. This means that, in the interests of giving them better quality-of-life, many of them could be spared this stressful procedure. This could cause a paradigm shift in the treatment of primary metastatic breast cancer."
"Primary operation in synchronous metastasized invasive breast cancer patients: first oncologic outcomes of the prospective randomized phase III ABCSG 28 POSYTIVE trial"
Fitzal, Bjelic, Steger, Singer, Marth, Hubalek, Schrenk, Balic, Knauer, Haid, Wette, Swoboda, Luisser, Fuegger, Greil, Soelkner, Fesl, Gnant on behalf of the ABCSG.