Prognostic and predictive factors in metastatic breast cancer
- Stephen Chia, MD, FRCPC
Stephen Chia, MD, FRCPC
- Associate Professor of Medicine
- British Columbia Cancer Agency
Although metastatic breast cancer (MBC) is unlikely to be cured, meaningful improvements in survival have been seen, coincident with the introduction of newer systemic therapies [1-3]. Median overall survival (OS) approaches two years, although this can range from a few months to many years . As greater knowledge is generated regarding the specific molecular alterations associated with individual breast cancers, it will be of paramount importance to distinguish the differences between the multitude of prognostic factors likely expressed versus the few predictive factors that will help select specific therapy(s).
This topic reviews prognostic factors for patients with metastatic breast cancer. A further discussion of prognostic and predictive factors utilized in primary breast cancer (for patients with non-metastatic disease) is covered separately. (See "Prognostic and predictive factors in early, non-metastatic breast cancer".)
PROGNOSTIC VERSUS PREDICTIVE FACTORS
By definition, a prognostic factor is capable of providing information on clinical outcome at the time of diagnosis, or at various times during the patient’s course with metastatic disease, independent of therapy. Such markers are usually indicators of growth, invasion, and metastatic potential [5,6]. In contrast, a predictive factor is capable of providing information on the likelihood of response to a given therapeutic modality. Such markers are either within the target of the treatment, the surrounding stroma, or serve as modulators or epiphenomena related to expression and/or function of the target. Although they can be separately classified, several factors in breast cancer are both prognostic and predictive (eg, the presence of over-expression of the human epidermal growth factor receptor 2 [HER2]).
The most useful prognostic factors are clinically based. While circulating tumor cells (CTCs) are also prognostic, their role in the clinical management of patients with metastatic breast cancer is not clear. These are summarized below.
●Relapse-free interval of ≥2 years is more favorable than a shorter time to relapse [7-10].
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