Effect of adjuvant chemotherapy on outcome in patients with metastatic breast carcinoma treated with first-line doxorubicin-containing chemotherapy

BACKGROUND. The objective of the current study was to analyze the impact of adjuvant chemotherapy in comparison with other prognostic parameters on th e outcome of a series of patients with breast carcinoma at time of metastat ic recurrence. METHODS. Data from 1430 patients accrued in 8 prospective trials of anthrac ycline-based first-line chemotherapy conducted at the Institut Curie betwee n 1977 and 1992 were reviewed. RESULTS, Patients who had not received adjuvant chemotherapy had better res ponse rates (66%) than pretreated patients (56%; P < 0.0001). Median overal l survival rates after metastatic recurrence were 26 months compared with 1 9 months, respectively (P < 0.0001). Local and regional recurrences as well as the number of organ sites involved with metastatic disease were reduced in patients who had received adjuvant chemotherapy. In a multivariate anal ysis, the following parameters if present at the initiation of treatment we re associated with poor outcome: elevated lactico dehydrogenase (LDH), low Karnofsky index, short disease free interval, more than two involved sites, liver involvement, and prior adjuvant chemotherapy. This adverse prognosti c effect of prior adjuvant chemotherapy was independent of the type of drug s and of the duration of the treatment and was present even in the subgroup patients with prolonged disease free intervals longer than 48 months. CONCLUSIONS. Adjuvant chemotherapy adversely affects overall response rates and overall survival rates in patients with metastatic breast carcinoma tr eated with first-line anthracycline based chemotherapy. Cancer 2001;91:1079 -89. (C) 2001 Americnn Cancer Society.