LONG-TERM FOLLOW-UP OF PATIENTS WITH COMPLETE REMISSION FOLLOWING COMBINATION CHEMOTHERAPY FOR METASTATIC BREAST-CANCER

Purpose: To determine the long-term clinical course of patients with m etastatic breast cancer (MBC) who achieved a complete remission with d oxorubicin-alkylating agent-containing combination chemotherapy progra ms, Patients and Methods: To assess the long-term prognosis of MBC, we reviewed our experience with 1,581 patients treated on consecutive do xorubicin and alkylating agent-containing front-line treatment protoco ls between 1973 and 1982. Treatment was administered for a maximum dur ation of 2 years. Characteristics of long-term survivors were evaluate d, and hazard rates for progression were calculated. Results: From thi s group, 263 (16.6%) achieved complete responses (CR) and 49 (3.1%) re mained in CR for more than 5 years. After a median duration of 191 mon ths, 26 patients remain in first CR, four patients died in CR at times ranging from 118 to 234 months, 18 patients died of breast cancer, an d one is alive with metastatic disease. Compared with the overall CR a nd total patient populations, the longterm CR group held more premenop ausal patients, a younger median age, a lower tumor burden, and better performance status. The hazard function shows a substantial drop in r isk of progression after approximately 3 years from initiation of ther apy. Ten long-term CR patients developed second primary cancers: breas t (3), ovary (2), pancreas (1), endometrium (1), colon (1), heed and n eck (1), and lung (1). Conclusion: Most patients with MBC treated with system therapies have only temporary responses to treatment, but some patients continue in CR following initial treatment. These data show that a small percentage of patient achieve long-term remissions with s tandard chemotherapy regimens. Remission consolidation strategies are needed. (C) 1996 by American Society of Clinical Oncology.