Mathias Neron1, Christophe Sajous2, Simon Thezenas3, Sophie Piperno-Neumann4, Fabien Reyal5, Marick Laé6, Camille Chakiba7, Nicolas Penel8, Thomas Ryckewaert8, Charles Honoré9, François Bertucci10, Audrey Monneur10, Sébastien Salas11, Florence Duffaud11, Esma Saada-Bouzid12, Nicolas Isambert13, Mehdi Brahmi2, Isabelle Ray-Coquard2, Jean-Yves Blay2, Nelly Firmin14. 1. Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France. mathias.neron@orange.fr. 2. Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France. 3. Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France. 4. Department of Medical Oncology, Institut Curie, Paris, France. 5. Department of Surgical Oncology, Institut Curie, Paris, France. 6. Department of Pathology, Institut Curie, Paris, France. 7. Department of Medical Oncology, Institut Bergonié, Bordeaux, France. 8. Department of Medical Oncology, Centre Oscar Lambret, Lille, France. 9. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France. 10. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France. 11. Department of Medical Oncology, CHU La Timone, Marseille, France. 12. Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France. 13. Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France. 14. Department of Medical Oncology, Institut du cancer Montpellier, Univ Montpellier, Montpellier, France.
Abstract
BACKGROUND: Metastatic phyllodes tumors have poor prognosis with median overall survival of 11.5 months. The objective of this study is to identify prognostic factors and the best options for management of metastatic malignant phyllode tumors (MMPTs). PATIENTS AND METHODS: A multicentric retrospective study, including cases of MMPT from 10 sarcoma centers, was conducted. The primary end-point was overall survival (OS), and the secondary end-point was the clinical benefit of chemotherapy (CBCT) rate. RESULTS: 51 MMPT patients were included. Median time from diagnosis to metastatic recurrence was 13 months. Management of MMPT consisted in surgery of the metastatic disease for 16 patients (31.3%), radiation therapy of the metastatic disease for 15 patients (31.9%), and chemotherapy for 37 patients (72.5%). Median follow-up was 62.1 months [95% confidence interval (CI) 31-80 months]. Median OS was 11.5 months (95% CI 7.5-18.7 months). On multivariate analysis, two or more metastatic sites [hazard ratio (HR) 2.81, 95% CI 1.27-6.19; p = 0.01] and surgery of metastasis (HR 0.33, 95% CI 0.14-0.78; p = 0.01) were independently associated with OS. The CBCT rate was 31.4% and 16.7% for the first and second lines. Polychemotherapy was not superior to single-agent therapy. Alkylating-agent-based chemotherapy, possibly associated with anthracyclines, was associated with a better CBCT rate than anthracyclines alone (p = 0.049). CONCLUSIONS: The results of this study emphasize the impact of the number of metastatic sites on survival of MMPT patients and the leading role of metastasis surgery in MMPT management. If systemic therapy is used, it should include alkylating agents, which are associated with a better clinical benefit.
BACKGROUND: Metastatic phyllodes tumors have poor prognosis with median overall survival of 11.5 months. The objective of this study is to identify prognostic factors and the best options for management of metastatic malignant phyllode tumors (MMPTs). PATIENTS AND METHODS: A multicentric retrospective study, including cases of MMPT from 10 sarcoma centers, was conducted. The primary end-point was overall survival (OS), and the secondary end-point was the clinical benefit of chemotherapy (CBCT) rate. RESULTS: 51 MMPT patients were included. Median time from diagnosis to metastatic recurrence was 13 months. Management of MMPT consisted in surgery of the metastatic disease for 16 patients (31.3%), radiation therapy of the metastatic disease for 15 patients (31.9%), and chemotherapy for 37 patients (72.5%). Median follow-up was 62.1 months [95% confidence interval (CI) 31-80 months]. Median OS was 11.5 months (95% CI 7.5-18.7 months). On multivariate analysis, two or more metastatic sites [hazard ratio (HR) 2.81, 95% CI 1.27-6.19; p = 0.01] and surgery of metastasis (HR 0.33, 95% CI 0.14-0.78; p = 0.01) were independently associated with OS. The CBCT rate was 31.4% and 16.7% for the first and second lines. Polychemotherapy was not superior to single-agent therapy. Alkylating-agent-based chemotherapy, possibly associated with anthracyclines, was associated with a better CBCT rate than anthracyclines alone (p = 0.049). CONCLUSIONS: The results of this study emphasize the impact of the number of metastatic sites on survival of MMPT patients and the leading role of metastasis surgery in MMPT management. If systemic therapy is used, it should include alkylating agents, which are associated with a better clinical benefit.