Surgery has survival benefits for male patients with stage IV breast cancer who are receptive to systemic therapy

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With increasingly effective treatments available, best practices for male breast cancer patients must evolve as they have for women with breast cancer in recent years, according to the findings of ‘a new study.

CHICAGO, 24 October 2021 / PRNewswire / –

Key points to remember

  • Men with stage IV breast cancer who are receptive to systemic treatment will benefit from surgery.

  • Patients who received trimodal therapy including systemic therapy, surgery, and radiation therapy also benefited compared to simple systemic therapy.

  • The authors hope their findings will prompt reconsideration of the National Comprehensive Cancer Network’s guidelines for this group of male breast cancer patients, which now recommends systemic treatment with surgery only to be used as a palliative measure.

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, a surgical resident at Pennsylvania 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,” said Daleela G. Dodge, MD, FACS, surgeon GP at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania, and co-author of the study.

“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 it 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.

The other authors of the study are Rolfy Perez Holguin, MD; Guillaume Wong, TO DO; Christopher McLaughlin, doctor of medicine; Elizabeth J. Olecki, doctor of medicine; Chan shen, PhD.

There are no author disclosures to report.

“FACS” means that a surgeon is a member of the American College of Surgeons.

Quote: Stahl KA, et al. Benefits of surgical treatment in male patients with stage IV breast cancer with known hormone receptor status. Presentation of the scientific forum. American College of Surgeons Clinical Congress 2021.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to raise the standards of surgical training and practice and to improve the quality of care for surgical patients. His accomplishments have placed him at the forefront of American surgery and have made the College a strong advocate for all surgical patients. The College has over 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

Surgery may improve survival in men with stage IV breast cancer who are receptive to systemic treatment

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SOURCE American College of Surgeons


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