Effect of neoadjuvant chemotherapy regimen on relapse-free survival among patients with breast cancer achieving a pathologic complete response: an early step in the de-escalation of neoadjuvant chemotherapy
| Autor: | Sami I. Bashour, Nuhad K. Ibrahim, Kenneth R. Hess, Anna Weiss, Alastair M. Thompson |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Oncology
De-escalation of chemotherapy Adult Bridged-Ring Compounds medicine.medical_specialty Receptor ErbB-2 Breast Neoplasms lcsh:RC254-282 Neoadjuvant chemotherapy Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine Pathologic complete response Antineoplastic Combined Chemotherapy Protocols medicine Humans Stage IIIC 030212 general & internal medicine Stage (cooking) Aged Taxane Survival after pCR business.industry Hazard ratio Cancer Middle Aged lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Chemotherapy regimen Neoadjuvant Therapy Regimen Doxorubicin 030220 oncology & carcinogenesis Female Taxoids Neoplasm Recurrence Local business Research Article |
| Zdroj: | Breast Cancer Research : BCR Breast Cancer Research, Vol 20, Iss 1, Pp 1-10 (2018) |
| ISSN: | 1465-542X 1465-5411 |
| Popis: | Background Patients with breast cancer who have a pathologic complete response (pCR) to neoadjuvant chemotherapy (NACT) have improved survival. We hypothesize that once pCR has been achieved, there is no difference in subsequent postsurgical recurrence-free survival (RFS), whichever NACT regimen is used. Methods Data from patients with breast cancer who achieved pCR after NACT between 1996 and 2011 were reviewed. RFS was estimated by the Kaplan-Meier method, and differences between groups were assessed using log-rank testing. Cox proportional hazards regression analysis adjusted for age, menopausal status, stage, grade, tumor subtype, and adjuvant endocrine HER2-targeted radiation treatment. Results Among 721 patients who achieved pCR after NACT, 157 (21.8%) were hormone receptor-positive (HR), 310 (43.3%) were HER2-amplified, and 236 (32.7%) were triple-negative; 292 (40.5%) were stage IIA, 153 (21.2%) were stage IIB, 78 (10.8%) were stage IIIA, 66 (9.2%) were stage IIIB, and 132 (18.3%) were stage IIIC. Most patients (367 [50.9%]) had been treated with adriamycin-based chemotherapy plus taxane (A + T), 56 (7.8%) without taxane (A no T), 227 (31.5%) with HER2-targeted therapy, and 71 (9.8%) provider choice. Median follow-up was 7.1 years. Adjuvant chemotherapy was employed in 196 (27%) patients, adjuvant endocrine in 261 (36%), and adjuvant radiation in the majority (559 [77.5%]). There was no statistically significant difference in RFS by NACT group. Adjusted RFS hazard ratios, comparing each treatment with the reference group A + T, were 1.25 (95% CI 0.47–3.35) for A no T, 0.90 (95% CI 0.37–2.20) for HER2-targeted therapy, and 1.28 (95% CI 0.55–2.98) for provider choice. Conclusions These data suggest that postsurgical RFS is not significantly influenced by the choice of NACT or cancer subtype among patients achieving pCR. Electronic supplementary material The online version of this article (10.1186/s13058-018-0945-7) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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