Benefit from anthracyclines in relation to biological profiles in early breast cancer
| Autor: | Andrea, Rocca, Sara, Bravaccini, Emanuela, Scarpi, Anita, Mangia, Stella, Petroni, Maurizio, Puccetti, Laura, Medri, Luigi, Serra, Monica, Ricci, Serenella, Cerasoli, Nicoletta, Biglia, Roberta, Maltoni, Donata Casadei, Giunchi, Lorenzo, Gianni, Amelia, Tienghi, Mario, Brandi, Marina, Faedi, Monica, Faedi, Piero, Sismondi, Angelo, Paradiso, Rosella, Silvestrini, Dino, Amadori |
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| Rok vydání: | 2013 |
| Předmět: |
Oncology
Adult Cancer Research medicine.medical_specialty Cyclophosphamide Receptor ErbB-2 medicine.medical_treatment Triple Negative Breast Neoplasms chemotherapy Disease-Free Survival Breast cancer antracyclines adjuvant biological profile Internal medicine Antineoplastic Combined Chemotherapy Protocols Biomarkers Tumor Medicine Humans skin and connective tissue diseases Epirubicin Chemotherapy business.industry Proportional hazards model Middle Aged medicine.disease Immunohistochemistry Ki-67 Antigen Methotrexate Receptors Estrogen Female Fluorouracil business Receptors Progesterone Adjuvant medicine.drug |
| Zdroj: | Breast cancer research and treatment. 144(2) |
| ISSN: | 1573-7217 |
| Popis: | There are no validated predictors of benefit from anthracyclines. We compared cyclophosphamide, methotrexate, 5-fluorouracil (CMF), and epirubicin in different sequences with CMF alone in a phase III trial on operable breast cancers. Outcomes were analyzed in relation to tumor biological profiles to identify potential predictors of the efficacy of different treatments/drug combinations. Patients with N− or 1–3N+ tumors, were randomized to receive (a) epirubicin (4 cycles) followed by CMF (4 cycles); (b) CMF (4 cycles) followed by epirubicin (4 cycles), or (c) CMF (6 cycles) alone. Immunohistochemical assessments of estrogen (ER) and progesterone (PgR) receptors, HER2 and Ki67 were available for 705 patients (arm A/B/C: 276/269/160). Prognostic and predictive relevance was analyzed by log-rank tests and Cox models. Ki67 > 20 % and absent/low expression of ER and PgR were associated with worsen disease-free (DFS) and overall survival (OS). In patients with triple negative tumors (ER−, PgR−, HER2−), epirubicin-containing regimens yielded better DFS (HR 0.33, 95 % CI 0.17–0.62, P = 0.0007) and OS (HR 0.24, 95 % CI 0.10–0.57, P = 0.001) compared with CMF alone, whereas no differences were found in patients with HER2-positive (HER2+, ER−, PgR−) subtype. Treatment by subtype interaction (HER2-positive vs. others) was significant for DFS (χ2 = 6.72, P = 0.009). In triple unfavorable (ER−, PgR−, Ki67 > 20 %) tumors, the use of epirubicin yielded better DFS (HR 0.45,95 % CI 0.26–0.78, P = 0.005) and OS (HR 0.30, 95 % CI 0.15–0.63, P = 0.001). Epirubicin-containing regimens seem to be superior to CMF alone in patients with highly proliferating, triple negative or triple unfavorable tumors . |
| Databáze: | OpenAIRE |
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