Transforming Care for Breast Cancer Patients

Women with stage IV breast cancer may live longer if they have surgery to remove the primary tumor, followed by standard therapy, than if they do just standard therapy alone. 

That is the result of an international clinical trial led by Atilla Soran, a clinical professor of surgery, University of Pittsburgh School of Medicine, and a breast surgical oncologist with UPMC CancerCenter. 

“Our findings will change the standard of care for women newly diagnosed with stage IV breast cancer,” said Soran, who is the study’s principal investigator. “We’ve shown that surgery to remove the primary tumor—either through lumpectomy or mastectomy—followed by standard therapy, is beneficial over no surgery.”

At stage IV, the cancer has spread to other organs or parts of the body. Also known as metastatic cancer, surgery has not traditionally been considered an option.

Soran began the trial in 2007, ultimately recruiting a total of 274 women newly diagnosed with stage IV breast cancer from 25 institutions. Half of the women received standard therapy, which avoids surgery and consists of a combination of chemotherapy, hormonal therapy, and targeted therapy. The other half of the group first had surgery to remove their primary breast tumor, followed by the standard therapy.

Nearly 42 percent of the women who received surgery lived to five years (60 months) after diagnosis, compared with less than 25 percent of the women who did not receive surgery. At about 40 months after diagnosis, the women who received the surgery plus standard therapy lived an average of nine months longer than their counterparts who received standard therapy alone. 

The trial also showed that surgery in younger women with less aggressive cancers resulted in longer average survival than in women with more aggressive cancers that had spread to the liver or lungs.

“Our thinking is similar to how you might approach a battle against two enemies,” Soran said. “First you quickly dispatch one army—the primary tumor—leaving you to concentrate all your efforts on battling the second army—any remaining cancer.”

 The results of this phase III randomized, controlled trial were presented last month at the  American Society of Clinical Oncology (ASCO) annual meeting in Chicago. The study was selected for the society’s “Best of ASCO,” which is research considered most relevant and significant to oncology. 

This research was funded primarily by the Turkish Federation of Breast Diseases Societies. The study received scientific advising from UPMC and assistance with statistical analysis from epidemiologists at the University of Pittsburgh Graduate School of Public Health.