Real-World Outcomes of Adjuvant Chemotherapy for Node-Negative and Node-Positive HER2-Positive Breast Cancer
| Autor: | Omar Farooq Khan, Karen King, Xanthoula Kostaras, Patricia A. Tang, Derek Tilley, Zachary William Neil Veitch, Domek Ribnikar, Sasha M. Lupichuk |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
0301 basic medicine Oncology medicine.medical_specialty Cyclophosphamide Receptor ErbB-2 medicine.medical_treatment Breast Neoplasms Disease-Free Survival Alberta 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Breast cancer Trastuzumab Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Breast Registries Survival rate Mastectomy Aged Retrospective Studies Chemotherapy business.industry Middle Aged medicine.disease Carboplatin Survival Rate 030104 developmental biology chemistry Docetaxel Chemotherapy Adjuvant Lymphatic Metastasis 030220 oncology & carcinogenesis Lymph Node Excision Female business medicine.drug Epirubicin |
| Zdroj: | Journal of the National Comprehensive Cancer Network. 17:47-56 |
| ISSN: | 1540-1413 1540-1405 |
| Popis: | Background: Comparative real-world outcomes for patients with HER2-positive (HER2+) breast cancer receiving adjuvant trastuzumab outside of clinical trials are lacking. This study sought to retrospectively characterize outcomes for patients with node-negative and node-positive breast cancer receiving adjuvant trastuzumab in combination with docetaxel/cyclophosphamide (DCH), docetaxel/carboplatin/trastuzumab (TCH), or fluorouracil/epirubicin/cyclophosphamide followed by docetaxel/trastuzumab (FEC-DH) chemotherapy in Alberta, Canada, from 2007 through 2014. Methods: Disease-free survival and overall survival (OS) analyses for node-negative cohorts receiving DCH (n=111) or TCH (n=371) and node-positive cohorts receiving FEC-DH (n=146) or TCH (n=315) were compared using chi-square, Kaplan-Meier, or Cox multivariable analysis where appropriate. Results: Median follow-up was similar in node-negative (63.9 months) and node-positive (69.0 months) cohorts. The 5-year OS rates in patients with node-negative disease receiving DCH or TCH were similar (95.2% vs 96.9%; P=.268), whereas 5-year OS rates were higher but nonsignificant for patients with node-positive disease treated with FEC-DH compared with TCH (95.2% vs 91.4%; P=.160). Subgroup analysis of node-positive cohorts showed significantly improved OS with FEC-DH versus TCH in patients with estrogen receptor (ER)/progesterone receptor (PR)-positive breast cancer (98.3% vs 91.6%, respectively; P=.014). Conversely, patients with ER/PR-negative disease showed a nonsignificant trend toward higher OS rates with TCH versus FEC-DH (91.6% vs 83.3%, respectively; P=.298). Given the retrospective design, we were unable to capture all potential covariates that may have impacted treatment assignment and/or outcomes. Furthermore, cardiac toxicity data were unavailable. Conclusions: Survival rates of patients with HER2+ breast cancer in our study are comparable to those seen in clinical trials. Our findings support chemotherapy de-escalation in patients with node-negative disease and validate the efficacy of FEC-DH in those with node-positive disease. |
| Databáze: | OpenAIRE |
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