Medline ® Abstracts for References 32,33
of 'Adjuvant chemotherapy for HER2-negative breast cancer'
Does timing of adjuvant chemotherapy for early breast cancer influence survival?
Shannon C, Ashley S, Smith IE
J Clin Oncol. 2003;21(20):3792.
PURPOSE: Theoretically, patients with early breast cancer might benefit from starting adjuvant chemotherapy soon after surgery, and this would have important clinical implications. We have addressed this question from a large, single-center database in which the majority of patients received anthracyclines.
PATIENTS AND METHODS: A total of 1161 patients from a prospectively maintained database treated with adjuvant chemotherapy for early breast cancer at the Royal Marsden Hospital (London, United Kingdom), including 686 (59%) receiving anthracyclines, were retrospectively analyzed. The disease-free survival (DFS) and overall survival (OS) of the 368 patients starting chemotherapy within 21 days of surgery (group A) were compared with those of the 793 patients commencing chemotherapy>or= 21 days after surgery (group B). Median follow-up time was 39 months (range, 12 to 147 months).
RESULTS: No significant difference in 5-year DFS was found between the two groups overall (70% for group A v 72% for group B; P =.4) or in any subgroup. Likewise, there was no difference in 5-year OS (82% for group A v 84% for group B; P =.2) or when the interval to the start of chemotherapy was considered as a continuous variable (P =.4).
CONCLUSION: We have been unable to identify any significant survival benefit from starting adjuvant chemotherapy early after surgery, either overall or in any subset of patients.
Breast Unity, Royal Marsden Hospital, United Kingdom.
Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer.
Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, Olivotto IA
J Clin Oncol. 2006;24(30):4888.
PURPOSE: To determine if time to start of adjuvant chemotherapy after curative surgery influences survival in early-stage breast cancer.
PATIENTS AND METHODS: A retrospective review was conducted of 2,594 patients receiving adjuvant chemotherapy for stage I and II breast cancer between 1989 and 1998 at the British Columbia Cancer Agency. Relapse-free survival (RFS) and overall survival (OS) were compared among patients grouped by time from definitive curative surgery to start of adjuvant chemotherapy (<or = 4 weeks,>4 to 8 weeks,>8 to 12 weeks, and>12 to 24 weeks).
RESULTS: RFS and OS were similar for women starting chemotherapy up to 12 weeks after surgery. OS hazard ratio (univariate) for initiation of chemotherapy more than 12 weeks compared with 12 weeks or less after surgery was 1.5 (95% CI, 1.07 to 2.10; P = .017). Five-year OS rates were 84%, 85%, 89%, and 78%, (log-rank P = .013); RFS rates were 74%, 79%, 82%, and 69% (log-rank P = .004) for patients starting chemotherapy 4 weeks or fewer, more than 4 to 8 weeks, more than 8 to 12 weeks, and more than12 to 24 weeks after surgery, respectively. In multivariate analysis, independent prognostic factors were grade, size, nodal status, estrogen receptor, age, and lymphatic and/or vascular invasion. Initiation of adjuvant chemotherapy more than 12 weeks from surgery remained significantly associated with inferior survival, with a hazard ratio of 1.6 (95% CI, 1.2 to 2.3; P = .005).
CONCLUSION: This retrospective analysis suggests that adjuvant chemotherapy is equally effective up to 12 weeks after definitive surgery but that RFS and OS appear to be compromised by delays of more than 12 weeks after definitive surgery.
Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver. firstname.lastname@example.org