Efficacy Of Adjuvant Chemotherapy According To Hormone Receptor Status
Efficacy Of Adjuvant Chemotherapy According To Hormone Receptor Status
Introduction: Breast cancer at a young age is associated with an unfavorable prognosis. Very young patients with breast cancer therefore are advised to undergo adjuvant chemotherapy irrespective of tumor stage or grade. However, chemotherapy alone may not be adequate in young patients with hormone receptor-positive breast cancer. Therefore, we studied the effect of adjuvant chemotherapy in young patients with breast cancer in relation to hormone receptor status.
Methods: Paraffin-embedded tumor material was collected from 480 early-stage breast cancer patients younger than 41 years who participated in one of four European Organization for Research and Treatment of Cancer trials. Using immunohistochemistry on the whole series of tumors, we assessed estrogen receptor (ER) status and progesterone receptor (PgR) status in a standardized way. Endpoints in this study were overall survival (OS) and distant metastasis-free survival (DMFS). The median follow-up period was 7.3 years.
Results: Overall, patients with ER-positive tumors had better OS rates (hazard ratio [HR] 0.63; P = 0.02) compared with those with ER-negative tumors. However, in the subgroup of patients who received chemotherapy, no significant difference in OS (HR 0.87; P = 0.63) and DMFS (HR 1.36; P = 0.23) was found between patients with ER-positive tumors or those with ER-negative tumors. These differences were similar for PgR status.
Conclusion: Young patients with hormone receptor-positive tumors benefit less from adjuvant systemic chemotherapy than patients with hormone receptor-negative tumors. These results confirm that chemotherapy alone cannot be considered optimal adjuvant systemic treatment in breast cancer patients 40 years old or younger with hormone receptor-positive tumors.
Breast cancer in premenopausal women is associated with worse outcome compared with postmenopausal patients. Approximately 7% of women diagnosed with breast cancer are younger than 40 years old. Very young women (that is, younger than 35 years old), especially, are at a high risk of developing distant metastases. Therefore, they are recommended to receive adjuvant systemic chemotherapy regardless of tumor stage or grade. In addition, high local regional recurrence rates after breast-conserving therapy have been reported in young premenopausal patients with breast cancer. Although it is clear that young age is an independent prognosticator of adverse outcome in breast cancer, controversies regarding the optimal treatment in this population exist.
Adjuvant systemic chemotherapy in premenopausal patients has been shown to improve survival, but controversy about the role of chemotherapy in patients with hormone receptor-positive tumors still exists. Aebi and colleagues clearly showed that the endocrine effects of chemotherapy alone might not be sufficient for very young patients with breast cancer. In this study, it was shown that estrogen receptor (ER)-positive tumors in patients younger than 35 years and treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) had a significantly worse disease-free survival compared with ER-negative patients.
To detect whether we could confirm these data by finding similar results, we studied the efficacy of chemotherapy in young patients with breast cancer according to ER status and progesterone receptor (PgR) status and selected patients 40 years old or younger at the time of primary diagnosis from four European Organization for Research and Treatment of Cancer (EORTC) trials that were conducted by the EORTC Breast Cancer Group and Radiotherapy Group.
Abstract and Introduction
Abstract
Introduction: Breast cancer at a young age is associated with an unfavorable prognosis. Very young patients with breast cancer therefore are advised to undergo adjuvant chemotherapy irrespective of tumor stage or grade. However, chemotherapy alone may not be adequate in young patients with hormone receptor-positive breast cancer. Therefore, we studied the effect of adjuvant chemotherapy in young patients with breast cancer in relation to hormone receptor status.
Methods: Paraffin-embedded tumor material was collected from 480 early-stage breast cancer patients younger than 41 years who participated in one of four European Organization for Research and Treatment of Cancer trials. Using immunohistochemistry on the whole series of tumors, we assessed estrogen receptor (ER) status and progesterone receptor (PgR) status in a standardized way. Endpoints in this study were overall survival (OS) and distant metastasis-free survival (DMFS). The median follow-up period was 7.3 years.
Results: Overall, patients with ER-positive tumors had better OS rates (hazard ratio [HR] 0.63; P = 0.02) compared with those with ER-negative tumors. However, in the subgroup of patients who received chemotherapy, no significant difference in OS (HR 0.87; P = 0.63) and DMFS (HR 1.36; P = 0.23) was found between patients with ER-positive tumors or those with ER-negative tumors. These differences were similar for PgR status.
Conclusion: Young patients with hormone receptor-positive tumors benefit less from adjuvant systemic chemotherapy than patients with hormone receptor-negative tumors. These results confirm that chemotherapy alone cannot be considered optimal adjuvant systemic treatment in breast cancer patients 40 years old or younger with hormone receptor-positive tumors.
Introduction
Breast cancer in premenopausal women is associated with worse outcome compared with postmenopausal patients. Approximately 7% of women diagnosed with breast cancer are younger than 40 years old. Very young women (that is, younger than 35 years old), especially, are at a high risk of developing distant metastases. Therefore, they are recommended to receive adjuvant systemic chemotherapy regardless of tumor stage or grade. In addition, high local regional recurrence rates after breast-conserving therapy have been reported in young premenopausal patients with breast cancer. Although it is clear that young age is an independent prognosticator of adverse outcome in breast cancer, controversies regarding the optimal treatment in this population exist.
Adjuvant systemic chemotherapy in premenopausal patients has been shown to improve survival, but controversy about the role of chemotherapy in patients with hormone receptor-positive tumors still exists. Aebi and colleagues clearly showed that the endocrine effects of chemotherapy alone might not be sufficient for very young patients with breast cancer. In this study, it was shown that estrogen receptor (ER)-positive tumors in patients younger than 35 years and treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) had a significantly worse disease-free survival compared with ER-negative patients.
To detect whether we could confirm these data by finding similar results, we studied the efficacy of chemotherapy in young patients with breast cancer according to ER status and progesterone receptor (PgR) status and selected patients 40 years old or younger at the time of primary diagnosis from four European Organization for Research and Treatment of Cancer (EORTC) trials that were conducted by the EORTC Breast Cancer Group and Radiotherapy Group.
