Adjuvant chemotherapy in young breast cancer patients with endrocrine receptor (ER) disease

Abstract BackgroundWith the increase in socioeconomic status and development of early screening technologies, the proportion of young breast cancer has gradually increased. However, epidemiological research on breast cancer in young women is lagging. There is a lack of diagnosis and treatment guidelines specifically for young breast cancer patients. MethodsThis is an single-center, retrospective cohort study which adopted 2,142 women ≤ 41 years who were diagnosed with stage I-III invasive breast cancer. Patients were grouped into hormone receptor-positive and -negative groups. Variance of common characteristics between the two groups were compared using Chi-square test, Fisher-exact test and Wilcoxon rank sum test. Cox proportional hazards regression was employed for survival estimation and Kaplan–Meier curves were used to graphically present the survival data. Propensity score matching was used to balanced covariates between patients who received or not received the same treatment. ResultsThe median age of the whole cohort was 37 (16-40), and 75.0% suffered from hormone receptor (HR) positive tumors. Modified radical mastectomy was the most frequent surgery (77.7%), and 78.7% women received adjuvant chemotherapy. Adjuvant radiotherapy was implemented in 39.0% of patients, and 58.3% women did not receive radiotherapy. The HR-positive status independently predicted unfavorable overall survival (OS, HR = 1.50, 95% CI 1.03-2.21, P = 0.04) and invasive disease-free survival (iDFS, HR = 1.47, 95% CI 1.05-2.05, P = 0.02). After propensity score matching (PSM), adjuvant chemotherapy (HR = 0.47, 95% CI 0.26-0.87, P = 0.02), and adjuvant radiotherapy (HR = 0.54, 95% CI 0.37-0.78, P = 0.001) improved OS significantly. Adjuvant chemotherapy predicted favorable iDFS (HR = 0.60, 95% CI 0.38-0.94, P = 0.03). Endocrine therapy improved both OS and iDFS in patients with HR-positive disease. ConclusionThe number of young women with breast cancer is gradually increasing, and these women have worse survival outcomes than their elder counterparts. HR-positive disease predicted worse long-term survival outcomes. Adjuvant chemotherapy and adjuvant radiotherapy were required for all of the young patients. Young women with HR-positive disease can benefit from endocrine therapy. No clear benefit was seen from neoadjuvant chemotherapy in young women with early-stage breast cancer.

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Ovarian function preservation with GnRH agonist in young breast cancer patients: Does it impede the effect of adjuvant chemotherapy?

The Breast ◽

10.1016/j.breast.2014.07.005 ◽

2014 ◽

Vol 23 (5) ◽

pp. 670-675 ◽

Cited By ~ 9

Author(s):

Jiyoung Kim ◽

Minkook Kim ◽

Jun Ho Lee ◽

Hyunchul Lee ◽

Se Kyung Lee ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Gnrh Agonist ◽

Ovarian Function ◽

Breast Cancer Patients ◽

Function Preservation ◽

Young Breast Cancer

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Abstract P3-09-19: A prospective study of fertility preservation by controlled ovarian hyperstimulation (COH) without letrozole in young breast cancer patients before adjuvant chemotherapy: Preliminary results

10.1158/0008-5472.sabcs13-p3-09-19 ◽

2013 ◽

Author(s):

A Mailliez ◽

Y Vendel ◽

A Govaere ◽

S Jebert ◽

J Bonneterre ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Prospective Study ◽

Cancer Patients ◽

Fertility Preservation ◽

Controlled Ovarian Hyperstimulation ◽

Ovarian Hyperstimulation ◽

Breast Cancer Patients ◽

Young Breast Cancer ◽

A Prospective Study

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Efficacy of palonosetron-based antiemetic prophylaxis in breast cancer patients receiving anthracycline-containing adjuvant chemotherapy: A survey in 41 German gyneco-oncology practices.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19540 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19540-e19540

Author(s):

Joerg Peter Schilling ◽

Peter Klare ◽

Antje Wetzel ◽

Kornelia Kittel ◽

Hans-Joachim Hindenburg ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Rescue Medication ◽

Single Agent ◽

Complete Response ◽

Breast Cancer Patients ◽

Complete Control ◽

Antiemetic Guidelines ◽

Young Breast Cancer

e19540 Background: The emesis risk in young breast cancer (BC) patients (pts) receiving adjuvant anthracyclines (A) plus cyclophosphamide (C), taxanes or other cytotoxics is higher than anticipated earlier. Furthermore, antiemetic control seems to decline in subsequent cycles of chemotherapy (CT). The ASCO has classified AC to be highly emetogenic (HEC) in their antiemetic guidelines 2011. Palonosetron (P) is a 5-HT3-receptor-antagonist (5-HT3-RA) with higher receptor affinity and longer biological half-life than older compounds. Data suggest that Palonosetron is clinically more effective in the acute phase and that in contrast to the older 5-HT3-RA it is also effective in the delayed phase. P also showed to maintain its efficacy in subsequent cycles. Current antiemetic guidelines list palonosetron as preferred 5-HT3-RA in moderate emetogenic chemotherapy (MEC). Methods: To evaluate the efficacy of palonosetron after 4 cycles of A containing chemotherapy in BC patients, we have conducted a survey in 41 practices of the BNGO in Germany. Between Nov 2007 and Jan 2012 1299 patients have been documented. Median age was 55 years. Severity, frequency, duration and onset of N/V were recorded in a patient diary. Efficacy criteria were complete control CC (no V, no rescue, mild N); complete response (CR: no V, no rescue) and rescue medication. Results: At the beginning P was used as single agent (56%). Following the MASCC 2010 guidelines P was used in combination with dexamethasone (PDex, 15%) or plus dex and NK1-RA (PNDex, 23%), 16% of pts received additional medication. Efficacy after 4 cycles of CT: Overall (5 days): Complete control CC: (no V, no rescue, mild N) 63,3% of pts, complete response (CR: no V, no rescue) 73,7%; Rescue Medication was needed in 15,6% of pts. PDex CC 48,7%, CR 69,8 %, PNDex: CC 76,3%, CR % 83,33. N was also very well controlled: Overall (5 days) 56% of pts no nausea, 15% moderate N 3% severe N. Conclusions: Palonosetron in combination with dex and NK1-RA is very effective to control nausea and vomiting in A-based adjuvant chemotherapy in young breast cancer patients after 4 cycles of chemotherapy.

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