Systemic Adjuvant Therapy for Stage I Breast Cancer

PURPOSE: We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer. MATERIALS AND METHODS: A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations. RESULTS: Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor–negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines. CONCLUSION: Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.

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Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.4.1380 ◽

1998 ◽

Vol 16 (4) ◽

pp. 1380-1387 ◽

Cited By ~ 202

Author(s):

C Lindley ◽

S Vasa ◽

W T Sawyer ◽

E P Winer

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Adjuvant Therapy ◽

Sexual Function ◽

Cancer Patients ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Systemic Adjuvant Therapy

PURPOSE To evaluate the quality of life (QOL) of breast cancer patients who survived 2 to 5 years following initiation of adjuvant cytotoxic and/or hormonal therapy and to characterize relationships between QOL and patient physical symptoms, sexual function, and preferences regarding adjuvant treatment. PATIENTS AND METHODS Eighty-six patients who had completed systemic adjuvant therapy for early-stage breast cancer between 1988 and 1991 were surveyed by written questionnaire and telephone interview. Sociodemographic information was obtained for each patient, and patients were asked to complete the Functional Living Index-Cancer (FLIC), the Symptom Distress Scale (SDS), the Medical Outcomes Study (MOS) Short Form 36 (SF-36), a series of questions regarding sexual function, and a survey about preferences for adjuvant therapy in relation to possible benefit. RESULTS The mean FLIC score among all patients was 138.3 (+/- 12.2), which suggests a high level of QOL. The reported frequency of moderate to severe symptoms was generally low (ie, < 15%), with fatigue (31.4%), insomnia (23.3%), and local numbness at the site of surgery (22.1%) occurring with greatest frequency. Patients reported a wide range of sexual difficulties. Preference assessment showed that more than 65% of patients were willing to undergo 6 months of chemotherapy for a 5% increase in likelihood of cancer cure. CONCLUSION Self-rated QOL in breast cancer patients 2 to 5 years following adjuvant therapy was generally favorable. Less than one third of patients reported moderate to severe symptoms. Selected aspects of sexual function appeared to be compromised. The majority of patients indicated a willingness to accept 6 months of chemotherapy for small to modest potential benefit.

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Practice patterns in the use of adjuvant therapy for post-menopausal early-stage breast cancer in the pre- and post-Oncotype DX era.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21032 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21032-e21032

Author(s):

Asma Latif ◽

Alexander C. Small ◽

Erin L. Moshier ◽

Kerin B. Adelson ◽

George Raptis ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Hormonal Therapy ◽

Practice Patterns ◽

Early Stage ◽

Predictive Biomarkers ◽

Oncotype Dx ◽

Stage I ◽

Adjuvant Therapies ◽

Gene Assay

e21032 Background: Personalized oncology offers the promise of selectively applying therapeutics to patients most likely to benefit, while sparing those unlikely to benefit from potentially toxic therapies. Oncotype DX is a 21-gene assay utilized to identify hormone-receptor positive (HR+), node negative, breast cancer (Br CA) patients who may be successfully treated with adjuvant hormonal therapy alone. We hypothesized that practice patterns with adjuvant therapy have changed since the commercial availability of Oncotype DX in 2004. Methods: The Public National Cancer Database was queried to identify patients age ≥ 50 with stage I or II Br CA diagnosed from 2000 to 2008. Patients were classified by adjuvant therapy including hormone, chemotherapy, hormone and chemotherapy, and no hormone or chemotherapy. Log-binomial regression was used to estimate prevalence ratios for the proportion of patients receiving adjuvant therapies from 2000-2003 compared to 2004-2008. Results: 833,018 patients age ≥ 50 with stage I or II Br CA were identified. The application of adjuvant therapies for the periods pre- and post-availability of Oncotype DX are detailed in the Table. Conclusions: There has been significant increase (13%) in the use of hormonal therapy alone as adjuvant therapy for patients age ≥ 50 with HR+ stage I-II Br CA since commercial availability of Oncotype DX. While this has been slightly offset by a decrease in the use of chemotherapy plus hormonal therapy, there has been a larger decrease in the use of “no adjuvant therapy”. Data regarding predictive biomarkers should be captured by registries in an effort to determine the true impact of these tests on treatment utilization. [Table: see text]

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Node-negative minimal invasive breast cancer patients are not candidates for routine systemic adjuvant therapy

Cancer ◽

10.1002/1097-0142(19900715)66:2<199::aid-cncr2820660202>3.0.co;2-l ◽

1990 ◽

Vol 66 (2) ◽

pp. 199-205 ◽

Cited By ~ 30

Author(s):

Dutzu Rosner ◽

Warren W. Lane

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Cancer Patients ◽

Invasive Breast Cancer ◽

Minimal Invasive ◽

Breast Cancer Patients ◽

Node Negative ◽

Systemic Adjuvant Therapy

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Endocrine Factors in the Outcome of Systemic Adjuvant Therapy of Early Breast Cancer

Annals of the New York Academy of Sciences ◽

10.1111/j.1749-6632.1993.tb17223.x ◽

1993 ◽

Vol 698 (1 Breast Cancer) ◽

pp. 330-338 ◽

Cited By ~ 2

Author(s):

A. R. BIANCO ◽

S. PLACIDO ◽

F. PERRONE ◽

C. CARLOMAGNO ◽

M. LAURENTIIS ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Early Breast Cancer ◽

Systemic Adjuvant Therapy ◽

Endocrine Factors

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EGFR expression in breast cancer: Association with biologic phenotype, prognosis, and resistance to adjuvant therapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.513 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 513-513 ◽

Cited By ~ 5

Author(s):

M. F. Rimawi ◽

H. L. Weiss ◽

P. Bhatia ◽

G. Chamness ◽

R. M. Elledge

Keyword(s):

Breast Cancer ◽

Black Women ◽

Adjuvant Therapy ◽

Growth Factor Receptor ◽

Disease Free Survival ◽

Nodal Involvement ◽

Her2 Positive ◽

Egfr Expression ◽

Er Positive ◽

Systemic Adjuvant Therapy

513 Background: Expression of the epidermal growth factor receptor (EGFR) in preclinical models of breast cancer is associated with increased proliferation and resistance to apoptosis. In clinical studies, EGFR has been inconsistently linked to poor outcome. We hypothesized that EGFR expression, when objectively and uniformly assessed, is associated with an aggressive biologic phenotype and resistance to systemic adjuvant therapy. Methods: In a database of 54,865 patients with breast cancer, EGFR status was known on 2,567. EGFR levels were measured centrally by ligand binding assay performed on frozen tissue. Tumors with ≥10 fmol/mg of cytosol protein were prospectively deemed positive. Clinical and biological features of EGFR positive and negative tumors were compared. Disease-free survival (DFS) and overall survival (OS) were assessed in systemically untreated patients (untreated patients, n=1068) and those who received hormonal and/or chemotherapy (treated patients, n=1256). Results: 475 out of 2,567 tumors (18.5%) were EGFR positive. Compared to EGFR negative tumors, EGFR positive tumors were more common in younger (<50 years, 40% vs 24% p<0.0001), premenopausal (20% vs 10%, p<0.0001), and black women (10% vs 6% p=0.005). EGFR expression was associated with larger tumors (64% vs 46%, p<0.0001), aneuploidy (68% vs 46%, p<0.0001), high S-phase fraction (53% vs 22%, p<0.0001), and nodal involvement (43% vs 37%, p=0.009). Co-expression of other biomarkers was also studied. EGFR positive tumors were more likely to be HER2 positive (26% vs 16%, p<0.0001), but less likely to be ER positive (60% vs 88%, p<0.0001), and PR positive (26% vs 65%, p<0.0001). In a multivariate analysis, EGFR expression independently correlated with worse DFS (HR=1.6, 95%CI=1.2–2.2, p=0.001) and OS (HR=1.7, 95% CI=1.2–2.4, p=0.001) in treated patients, but not in untreated patients. Conclusions: EGFR expression is more common in breast tumors in young and black women. It is associated with lower hormone receptor levels, higher proliferation, genomic instability, nodal involvement, and HER2 over-expression. It is correlated with significant resistance to adjuvant hormonal and chemotherapy. Blocking EGFR activity may help overcome this resistance in selected patients. No significant financial relationships to disclose.

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Axillary node staging for microinvasive breast cancer: Is it justified?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.7 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 7-7

Author(s):

J. M. Lyons ◽

M. Stempel ◽

K. J. Van Zee ◽

H. S. Cody

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Adjuvant Therapy ◽

Breast Cancer Mortality ◽

Cancer Center ◽

Lymph Node Staging ◽

Axillary Lymph ◽

Systemic Adjuvant Therapy

7 Background: DCIS with microinvasion (DCISM) is a lesion for which prognosis may be intermediate between that of DCIS and invasive breast cancer, but for which the role of axillary lymph node staging remains controversial. Here we report clinical characteristics and outcome in 112 patients with DCISM, with a particular focus on the role of sentinel lymph node (SLN) biopsy. Methods: From our prospective database we retrospectively identified 112 patients with a diagnosis of DCISM who had undergone SLN biopsy between 1996 and 2004 at Memorial Sloan-Kettering Cancer Center. Median follow up was 6 years. Results: We found positive SLN in 12% (14/112) of all patients, macrometastases in 2.7% (3/112) and micrometastases in 10% (11/112). We performed axillary dissection (ALND) in all patients with macrometastases (3/3), finding additional positive nodes in 66% (2/3), and in 27% of those with micrometastases (3/11), finding no additional positive nodes. Among patients with negative SLN (38% of whom received systemic therapy), there were 5 loco-regional recurrences (1 in the ipsilateral axilla, and 4 in the ipsilateral breast, all DCIS) and 4 contralateral second primary breast cancers. Among patients with positive SLN (86% of whom received systemic adjuvant therapy), there were no loco-regional or distant recurrences. Conclusions: Positive SLN were present in 12% of our patients with DCISM, none of whom experienced recurrence at 6 years’ follow up. SLN biopsy may be justified for DCISM, but is clearly most beneficial to identify a very small subset of DCISM patients (2.7%, with SLN macrometastases) who could benefit from systemic adjuvant therapy. Our data imply that between 125 and 250 SLN biopsy procedures would be required to avoid breast cancer mortality in 1 patient, and do not support the routine use of ALND for SLN-positive patients. We recommend a critical reappraisal of routine SLN biopsy for DCISM.

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