Breast cancer index (BCI) predicts benefit of two-and-a-half versus five years of extended endocrine therapy in HR+ breast cancer patients treated in the ideal trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 512-512
Author(s):  
Gerrit-Jan Liefers ◽  
Iris Noordhoek ◽  
Kai Treuner ◽  
Hein Putter ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Endocrine Therapy ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Ratio Test ◽  
Breast Cancer Patients ◽  
Extended Endocrine Therapy ◽  
The Ideal

512 Background: For postmenopausal women with hormone receptor positive (HR+) breast cancer, the optimal duration of extended endocrine therapy (EET), after completing 5 years of initial aromatase inhibitor (AI)–based adjuvant therapy, remains unclear. BCI [HOXB13/IL17BR (H/I)] is a gene expression-based biomarker that has been demonstrated to predict EET benefit in the MA.17 and Trans-aTTom studies in patients treated with adjuvant tamoxifen. The current study examined the ability of BCI (H/I) to predict endocrine benefit from 2.5 vs. 5 years of extended letrozole in the IDEAL trial. Methods: All patients with available tumor specimens were eligible for this blinded prospective-retrospective study. The primary endpoint was Recurrence-Free Interval (RFI). Median follow-up was 9.1 years from randomization. Kaplan-Meier and Cox proportional hazards regression analysis were used to analyze the differential benefit of EET with statistical significance of the interaction between BCI (H/I) and treatment assessed by likelihood ratio test. Results: 908 HR+ patients (73% pN+, median 59y, 45% pT1, 48% pT2, disease free at 2.5 years) were included, with 88% and 68% receiving prior treatment with an AI or chemotherapy, respectively. BCI by H/I status (High vs. Low) was significantly predictive of response from extended letrozole in the overall (N = 908) and pN+ (N = 664) cohorts. Notably, BCI (H/I) predicted EET benefit in patients that received any primary adjuvant therapy with an AI (N = 794). Treatment to biomarker interaction was significant in the overall (p = 0.045), pN+ (p = 0.029) and any prior AI (p = 0.025) cohorts, adjusted for age, pT stage, grade, nodal status, prior endocrine therapy and prior chemotherapy. Conclusions: Novel findings from this study demonstrate that BCI predicts endocrine benefit from extended letrozole in postmenopausal patients treated with primary adjuvant AI. These results support the growing body of evidence that BCI by H/I status predicts preferential endocrine response in distinct subgroups of patients, and further support its role as an important genomic tool to inform the risk-benefit regarding duration of extended endocrine therapy. Clinical trial information: NTR3077, BOOG 2006-05, Eudra-CT 2006-003958-16 . [Table: see text]

Breast Cancer Index and prediction of benefit from extended endocrine therapy based on treatment compliance: An IDEAL study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 531-531
Author(s):  
Gerrit-Jan Liefers ◽  
Iris Noordhoek ◽  
Kai Treuner ◽  
Hein Putter ◽  
Jenna Wong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Treatment Compliance ◽  
Significant Benefit ◽  
Endocrine Treatment ◽  
Breast Cancer Patients ◽  
Absolute Benefit ◽  
Breast Cancer Index ◽  
Extended Endocrine Therapy ◽  
The Ideal

531 Background: The IDEAL trial randomized hormone receptor-positive (HR+) breast cancer patients to 5 vs 2.5y of extended letrozole after completion of 5y of adjuvant endocrine therapy. In the parent trial, approximately 60% of patients overall were compliant with endocrine treatment (59% vs 74% compliance in 5y and 2.5y arms, respectively), with patient experiences as the most significant factors leading to treatment discontinuation. Breast Cancer Index is a gene expression-based signature that predicts which HR+ patients are likely to benefit from extended endocrine therapy (EET) vs those unlikely to benefit [BCI (H/I)-High and -Low, respectively]. The current study examined EET compliance and outcome by BCI (H/I) status in patients treated in the IDEAL trial. Methods: Patients with available primary tumor specimens were eligible for this blinded study. Primary endpoint was recurrence-free interval (RFI), including locoregional and distant recurrences. Kaplan-Meier and Cox proportional hazards regression analysis were used to analyze the benefit of EET. Non-compliance was defined as completion of ≤60% of treatment duration (≤3y for 5y arm; ≤1.5y for 2.5y arm) for any reason other than disease events. Overtreatment was defined as % compliant BCI (H/I)-Low patients in the 5y arm; undertreatment was % noncompliant BCI (H/I)-High patients in the 5y arm. Results: 908 HR+ patients (73% pN+, 59y, 45% pT1, 48% pT2) were included. 78% (n = 708) of patients were compliant, of which 48% (n = 338) were BCI (H/I)-High and 52% (n = 370) were BCI (H/I)-Low. In non-compliant patients (22%, n = 200), 45% (n = 91) were BCI (H/I)-High and 55% (n = 109) were BCI (H/I)-Low. BCI (H/I)-Low patients irrespective of compliance status did not derive significant benefit from EET (P = 0.922, compliant subset; 0.894 non-compliant subset). Compliant BCI (H/I)-High patients showed significant benefit from EET (HR 0.35, 95% CI 0.16-0.79; absolute benefit 11.7%; P = 0.008) whereas non-compliant BCI (H/I)-High patients did not (HR 0.75, 95% CI 0.17-3.35; absolute benefit 2.1%, P = 0.704). In this study, 38% of patients in the 5y EET arm were BCI (H/I)-Low and compliant and thus were overtreated, while 13% of patients in the 5y EET arm were BCI (H/I)-High and non-compliant and thus were undertreated. Conclusions: Patients that were BCI (H/I)-Low did not derive significant benefit from 5 vs 2.5y of EET even when compliant, and thus may be considered for treatment de-escalation. Importantly, BCI (H/I)-High patients with endocrine responsive disease showed significant improvements in outcome when compliant and should be guided to continue treatment. BCI may serve as an important genomic tool to increase EET compliance and identify patients that may be candidates for increased side effect management and support to potentially improve outcomes. Clinical trial information: NTR3077; BOOG 2006-05; Eudra-CT 2006-003958-16.

Specific Adverse Events Predict Survival Benefit in Patients Treated With Tamoxifen or Aromatase Inhibitors: An International Tamoxifen Exemestane Adjuvant Multinational Trial Analysis

2013 ◽  
Vol 31 (18) ◽  
pp. 2257-2264 ◽  
Author(s):  
Duveken B.Y. Fontein ◽  
Caroline Seynaeve ◽  
Peyman Hadji ◽  
Elysée T.M. Hille ◽  
Willemien van de Water ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adverse Events ◽  
Endocrine Therapy ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Endocrine Treatment ◽  
Survival Outcomes ◽  
Cox Proportional Hazards Models

Purpose Specific adverse events (AEs) associated with endocrine therapy and related to depletion or blocking of circulating estrogens may be related to treatment efficacy. We investigated the relationship between survival outcomes and specific AEs including vasomotor symptoms (VMSs), musculoskeletal adverse events (MSAEs), and vulvovaginal symptoms (VVSs) in postmenopausal patients with breast cancer participating in the international Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial. Patients and Methods Primary efficacy end points were disease-free survival (DFS), overall survival (OS), and distant metastases (DM). VMSs, MSAEs, and VVSs arising in the first year of endocrine treatment were considered. Patients who did not start or who discontinued their allocated therapy and/or had an event (recurrence/death) within 1 year after randomization were excluded. Landmark analyses and time-dependent multivariate Cox proportional hazards models assessed survival differences up to 5 years from the start of treatment. Results A total of 9,325 patients were included. Patients with specific AEs (v nonspecific or no AEs) had better DFS and OS (multivariate hazard ratio [HR] for DFS: VMSs, 0.731 [95% CI, 0.618 to 0.866]; MSAEs, 0.826 [95% CI, 0.694 to 0.982]; VVSs, 0.769 [95% CI, 0.585 to 1.01]; multivariate HR for OS: VMSs, 0.583 [95% CI, 0.424 to 0.803]; MSAEs, 0.811 [95% CI, 0.654 to 1.005]; VVSs, 0.570 [95% CI, 0.391 to 0.831]) and fewer DM (VMSs, 0.813 [95% CI, 0.664 to 0.996]; MSAEs, 0.749 [95% CI, 0.601 to 0.934]; VVSs, 0.687 [95% CI, 0.436 to 1.085]) than patients not reporting these symptoms. Increasing numbers of specific AEs were also associated with better survival outcomes. Outcomes were unrelated to treatment allocation. Conclusion Certain specific AEs are associated with superior survival outcomes and may therefore be useful in predicting treatment responses in patients with breast cancer treated with endocrine therapy.

Analysis of the prognostic value of the shed antigen of HER2/neu in premenopausal breast cancer patiens in the TABLE study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11007-11007
Author(s):  
D. Luftner ◽  
K. Pechlivanis ◽  
R. Geppert ◽  
A. Stroux ◽  
K. Possinger
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Prognostic Value ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Premenopausal Breast Cancer ◽  
The Third ◽  
Adjuvant Breast Cancer ◽  
Her 2 ◽  
Prognostic Importance

11007 Background: The HER-2/neu oncoprotein is a transmembrane tyrosine kinase that belongs to the family of epidermal growth factor receptors. It is known to be overexpressed in 20–40% of breast cancers. Increased serum HER-2/neu (sHER-2/neu) concentrations at the beginning of adjuvant breast cancer therapy have been shown to be of prognostic importance (Mehta et al, 1998). Using the sera from the Takeda® Adjuvant Breast Cancer Study with Leuprorelin (TABLE study), we tested for the prognostic value of sHER-2/neu. Methods: A total of 133 premenopausal, node-positive, hormone-receptor positive patients received either 11.25 mg of leuprorelin s.c. every 3 months over 2 years or CMF chemotherapy for 6 cycles. Blood samples were collected at baseline and at 3, 6, 12, 18, 24 and 30 mo. The primary endpoint of the study was to determine the relapse-free survival (RFS) after 2 years. sHER-2/neu was measured using a standardized ELISA (upper limit of normal 15 ng/ml). As the baseline sHER-2/neu concentrations ranged from 3.8–14.0 ng/ml, results were grouped in terciles. Data were analyzed using Kaplan-Meier and Cox Proportional Hazards survival analysis. Results: Material was available from 80 patients in leuprorelin arm and 53 patients in CMF arm. 65 of 133 patients had relapsed during the follow-up time of up 7 years after treatment. The median RFS was 62.9 mo. The RFS time depended on the concentrations of sHER-2/neu at baseline: RFS was significantly shorter in patients of the third tercile with sHER-2/neu levels >8.8 ng/ml than in patients of the first tercile with levels <7.2 ng/ml (p=0.0232). Five years after initial therapy, we found that 73% of patients in the first tercile group of baseline sHER-2/neu had no relapse. In the second tercile, 63.3% of patients were relapse-free, while in the third tercile only 47.2% of patients had not suffered from a relapse. Conclusions: Higher sHER-2/neu concentrations at the beginning of adjuvant therapy in the TABLE-Study have a prognostic importance for RFS. This observation was evaluated irrespective of the HER-2/neu tissue status and could be of clinically importance for adjuvant therapy with the monoclonal anti-HER-2/neu antibody trastuzumab or other anti-HER-2/neu targeted therapies. No significant financial relationships to disclose.

Risk stratification in earl- stage luminal breast cancer patients treated with and without RT.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 568-568 ◽  
Author(s):  
Charlotta Wadsten ◽  
Pat W. Whitworth ◽  
Rakesh Patel ◽  
Jess Savala ◽  
Fredrik Warnberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Risk Groups ◽  
Tissue Microarrays ◽  
Cox Proportional Hazards ◽  
Luminal Breast Cancer ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Kaplan Meier ◽  
Stage 1

568 Background: The goal was to develop and validate a biologic signature for 10-year ipsilateral invasive breast event (IBE) risk in luminal Stage 1 breast cancer (BC) patients treated surgically and either with or without radiation therapy (RT). Methods: This cohort was from Uppsala University and Västerås Hospitals diagnosed with Stage 1 BC and treated surgically between 1987 and 2004. Treatment was neither randomized nor strictly rules based, including adjuvant RT, Hormone Therapy (HT), and Chemotherapy (CT). Biomarkers (HER2, PR, Ki67, COX2, p16/INK4A, FOXA1 and SIAH2) were assessed on tissue microarrays in PreludeDx’s CLIA lab by board-certified pathologists. Risk groups were calculated using biomarkers and clinical factors age and size. A multivariate Cox proportional hazards analysis was used to determine hazard ratio for biologic signature. 10-year IBE risk was assessed using Kaplan-Meier survival analysis. Results: There were 423 luminal cases with biomarker data having 54 IBEs, and a median follow-up of 11.8 years. There were 372 patients treated with BCS and 51 with Mastectomy, and 325 received RT, 169 received HT, and 47 received CT. In a multivariate analysis, the biologic signature (HR = 1.6, p = 0.019) and RT (HR = 0.51, p = 0.027) were associated with IBE risk adjusting for other treatments (HT and CT) and Luminal A status (p = 0.37). For patients over 50 yrs of age with luminal A disease and treated without CT (n = 205), an elevated biologic signature identified a subset of patients with a 15% (+/- 14%) 10-year IBE risk without RT (n = 38) compared to a 4% (+/-6%) IBE risk with RT (n = 72), while patients with a low biologic signature had a 10-year IBE risk of 4% (+/- 4%) without RT (n = 26) and 3% (+/-5%) IBE risk with RT (n = 69). Conclusions: With further prospective validation, the biologic signature identified herein may provide a tool enabling improved management for women diagnosed with early luminal BC.

Comparative performance of Breast Cancer Index (BCIN+) and CTS5 in hormone receptor-positive (HR+) lymph node-positive (N+) breast cancer patients with one to three positive nodes (N1).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 555-555
Author(s):  
Dennis Sgroi ◽  
Yi Zhang ◽  
Catherine A. Schnabel
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Tumor Size ◽  
Risk Groups ◽  
Cox Proportional Hazards ◽  
Low Risk ◽  
Intermediate Risk ◽  
Breast Cancer Patients

555 Background: Identification of N+ breast cancer patients with a limited risk of recurrence improves selection of those for which chemotherapy and/or extended endocrine therapy (EET) may be most appropriate to reduce overtreatment. BCIN+ integrates gene expression with tumor size and grade, and is highly prognostic for overall (0-10yr) and late (5-10yr) distant recurrence (DR) in N1 patients. Clinical Treatment Score post-5-years (CTS5) is a prognostic model based on clinicopathological factors (nodes, age, tumor size and grade) and significantly prognostic for late DR. The current analysis compares BCIN+ and CTS5 for risk of late DR in N1 patients. Methods: 349 women with HR+, N1 disease and recurrence-free for ≥5 years were included. BCIN+ results were determined blinded to clinical outcome. CTS5 was calculated as previously described (Dowsett et al, JCO 2018; 36:1941). Kaplan-Meier analysis and Cox proportional hazards regression for late DR (5-15y) were evaluated. Results: 64% of patients were > 50 years old, 34% with tumors > 2cm, 79% received adjuvant chemotherapy and 64% received up to 5 years of ET. BCIN+ stratified 23% of patients as low-risk with 1.3% risk for late DR vs those classified as high-risk with 16.1% [HR 12.4 (1.7-90.4), p = 0.0014]. CTS5 classified patients into 3 risk groups: 29% of patients as low-risk (4.2% DR), 37% as intermediate-risk (10.6% DR), and 34% as high-risk (22.1% DR) [HR intermediate vs. low: 2.3 (0.7-7.0), p = 0.16; high vs. low: 5.3 (1.8-15.5), p = 0.002]. In a subset of patients who completed 5 years of ET (N = 223), BCIN+ identified 22% of patients as low-risk with a late DR rate of 2.1%, while CTS5 identified 29% and 37% of patients as low- and intermediate-risk with late DR rates of 5.2% and 10.3%, respectively. Conclusions: BCIN+ classified N1 patients into binary risk groups and identified 20% patients with limited risk of late DR ( < 2%) that may be advised to forego EET and its attendant toxicities/side effects. In comparison, CTS5 classified patients into 3 risk groups, with low- and intermediate-risk of late DR of 4-5% and 10%, wherein the risk-benefit profile for extension of endocrine therapy is less clear.

Race as an independent factor for survival in breast cancer patients according to analysis of the National Cancer Database (NCDB).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18155-e18155 ◽  
Author(s):  
Drew Carl Drennan Murray ◽  
Shruti Bhandari ◽  
Phuong Ngo ◽  
Sarah Mudra ◽  
Rachana Shirish Lele ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Proportional Hazards ◽  
Early Stage ◽  
Tumor Biology ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Independent Factor ◽  
Breast Cancer Patients ◽  
Delayed Treatment

e18155 Background: Black (B) women after early stage of diagnosis have been shown to have double the risk of white (W) women for failing to receive adjuvant chemotherapy. Despite lower incidence of breast cancer in B patients, they are more likely to die of the disease. Worse outcomes in B populations have been related to clinical and socioeconomic factors. However, the determination of improved access and its effects on survival in black patients remains uncertain. Methods: 1042844 patients diagnosed between 2004 and 2014 with stage I-III breast cancer were identified in the NCDB. Only W and B races were analyzed with established risk factors of age, stage, comorbidity score, and insurance status. Data was analyzed using univariable and multivariable logistic and Cox proportional hazards regression models. Odds Ratio (OR) for binary outcome, Hazard Ratio (HR) for time-to-event (survival) outcome along with 95% confidence interval (95% CI) are reported. Results: Among the total population 85.5% were W, 10.6% B, and 3.9% other. B were more likely to be uninsured (OR: 1.66; 95% CI: 1.59 - 1.72; p < 0.0001), or have Medicaid (OR: 2.01; 95% CI: 1.96 - 2.07; p < 0.0001). B were also diagnosed at later stage (stage 3 OR: 1.59; 95% CI: 1.57 - 1.63; p < 0.0001) with higher co-morbidities (OR: 2.49; 95% CI: 2.34 - 2.67; p < 0.0001) consistent with prior studies. B were more likely to experience delayed treatment (OR: 2.15; 95% CI: 2.10 - 2.20; p < 0.0001). B race remained an independent factor associated with higher likelihood of death compared to W patients (HR: 1.32; 95% CI: 1.3 - 1.34; p < 0.0001) in multivariable analysis. Conclusions: This large database study demonstrates that even when controlling for established risk factors such lack of insurance or Medicaid, higher comorbidities, and later stage at diagnosis, B patients were more likely to experience delays in treatment initiation and worse overall survival. This suggests race remains an independent risk factor for poor outcome even when clinical factors are matched. Further analysis including tumor biology should be examined to better understand this persistent disparity.

Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study

2005 ◽  
Vol 23 (34) ◽  
pp. 8597-8605 ◽  
Author(s):  
John J. Doyle ◽  
Alfred I. Neugut ◽  
Judith S. Jacobson ◽  
Victor R. Grann ◽  
Dawn L. Hershman
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Primary Tumors ◽  
Increased Risk

Purpose Adjuvant chemotherapy, especially with anthracyclines, is known to cause acute and chronic cardiotoxicity in breast cancer patients. We studied the cardiac effects of chemotherapy in a population-based sample of breast cancer patients aged ≥ 65 years with long-term follow-up. Patients and Methods In the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we analyzed treatments and outcomes among women ≥ 65 years of age who were diagnosed with stage I to III breast cancer from January 1, 1992 to December 31, 1999. Propensity scores were used to control for baseline heart disease (HD) and other known predictors of chemotherapy, and Cox proportional hazards models were used to estimate the risk of cardiomyopathy (CM), congestive heart failure (CHF), and HD after chemotherapy. Results Of 31,748 women with stage I to III breast cancer, 5,575 (18%) received chemotherapy. Chemotherapy was associated with younger age, fewer comorbidities, hormone receptor negativity, multiple primary tumors, and advanced disease. Patients who received chemotherapy were less likely than other patients to have pre-existing HD (45% v 55%, respectively; P < .001). The hazard ratios for CM, CHF, and HD for patients treated with doxorubicin (DOX) compared with patients who received no chemotherapy were 2.48 (95% CI, 2.10 to 2.93), 1.38 (95% CI, 1.25 to 1.52), and 1.35 (95% CI, 1.26 to 1.44), respectively. The relative risk of cardiotoxicity among patients who received DOX compared with untreated patients remained elevated 5 years after diagnosis. Conclusion When baseline HD was taken into account, chemotherapy, especially with anthracyclines, was associated with a substantially increased risk of CM. As the number of long-term survivors grows, identifying and minimizing the late effects of treatment will become increasingly important.

The HOXB13:IL17BR Expression Index Is a Prognostic Factor in Early-Stage Breast Cancer

2006 ◽  
Vol 24 (28) ◽  
pp. 4611-4619 ◽  
Author(s):  
Xiao-Jun Ma ◽  
Susan G. Hilsenbeck ◽  
Wilson Wang ◽  
Li Ding ◽  
Dennis C. Sgroi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factor ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Tamoxifen Treatment ◽  
Breast Cancer Patients ◽  
Node Negative

Purpose We previously identified three genes, HOXB13, IL17BR and CHDH, and the HOXB13:IL17BR ratio index in particular, that strongly predicted clinical outcome in breast cancer patients receiving tamoxifen monotherapy. Confirmation in larger independent patient cohorts was needed to fully validate their clinical utility. Patients and Methods Expression of HOXB13, IL17BR, CHDH, estrogen receptor (ER) and progesterone receptor (PR) were quantified by real-time polymerase chain reaction in 852 formalin-fixed, paraffin-embedded primary breast cancers from 566 untreated and 286 tamoxifen-treated breast cancer patients. Gene expression and clinical variables were analyzed for association with relapse-free survival (RFS) by Cox proportional hazards regression models. Results ER and PR mRNA measurements were in close agreement with immunohistochemistry. In the entire cohort, expression of HOXB13 was associated with shorter RFS (P = .008), and expression of IL17BR and CHDH was associated with longer RFS (P < .0001 for IL17BR and P = .0002 for CHDH). In ER+ patients, the HOXB13:IL17BR index predicted clinical outcome independently of treatment, but more strongly in node-negative patients. In multivariate analysis of the ER+ node-negative subgroup including age, PR status, tumor size, S phase fraction, and tamoxifen treatment, the two-gene index remained a significant predictor of RFS (hazard ratio = 3.9; 95% CI, 1.5 to 10.3; P = .007). Conclusion This tumor bank study demonstrated HOXB13:IL17BR index is a strong independent prognostic factor for ER+ node-negative patients irrespective of tamoxifen therapy.

scholarly journals 1577 Using CTS5 Calculator to Predict The 5-10-Year Risk of Late Distant Recurrence for Women With ER-Positive Breast Cancer Who Are Recurrence-Free 5 Years After Endocrine Therapy and To Reduce the Number of Patients Needing Discussion for The Extended Endocrine Therapy in The Breast MDTs: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Ahmed ◽  
P Kiruparan ◽  
D Debnath
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Maximum Level ◽  
Distant Recurrence ◽  
Evidence Based ◽  
Breast Cancer Patients ◽  
Improvement Project ◽  
Number Of Patients ◽  
Er Positive ◽  
Extended Endocrine Therapy

Abstract Introduction The increasing number of patients has created a pressure on the services provided that aim to ensure the maximum level of care, particularly MDT meetings. Using the CTS5 calculator can readily reduce the number of patients needing discussion for EET. This is will prevent delays in decisions made for patients and more importantly, an evidence-based tool will be used for more accurate results. Method A retrospective data collection was undertaken from the Breast MDT records, initially dating from January to December 2018. Then when the optional use of CTS5 was established, data were retrieved from August to October 2019. As per guidance for the use of the CTS5 calculator; Women were deemed low risk if their 5–10-year risk is less than 5%, intermediate if between 5–10%, and high risk if their 5–10-year risk is more than 10%. Finally, a prospective data collected from January to March 2020 where an agreement was made for all involved Surgeons to use the CTS5 calculator. Results Before Introducing the CTS5 Calculator, in 2018, the number of patients was 1523 from which 66 were for EET 4.3%. When CTS5 Calculator was first introduced, 1st of August - 31st October 2019, the percentage reduced to 4.1% and from January to March 2020, a further reduction 3.9% was noticed. Conclusions The CTS5 calculator is an effective evidence-based tool used to predict the risk of 5-10 years recurrence in breast cancer patients. Implementing it will reduce the number of patients needing discussion in Breast MDTs, sparing meetings’ and patients’ time.

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