Adjuvant Systemic Therapy and Survival after Breast Cancer

Olivotto, Ivo A.; Bajdik, Chris; Plenderleith, Ian H.; Coppin, Chris; Gelmon, Karen A.; Jackson, Stewart M.; Ragaz, Joseph; Wilson, Kenneth S.; Worth, Ann

doi:10.1056/nejm199403243301201

Cited by 77 publications

(37 citation statements)

References 13 publications

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“…Another study found variable responses to the Clinical Alert: in a single large metropolitan area, the major university hospital increased its use of adjuvant chemotherapy for all subsets of NNBC following the Clinical Alert, whereas the major community hospital did so only for some subsets (Studnicki et al, 1993). In Canada, health care is under provincial jurisdiction and the degree to which practice guidelines have been developed is varied (Olivotto et al, 1994;Browman et al, 1995). In British Columbia, province-wide guidelines for cancer care have been in place since the mid-1970s (Olivotto et al, 1994).…”

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confidence: 99%

“…In Canada, health care is under provincial jurisdiction and the degree to which practice guidelines have been developed is varied (Olivotto et al, 1994;Browman et al, 1995). In British Columbia, province-wide guidelines for cancer care have been in place since the mid-1970s (Olivotto et al, 1994). The guidelines are updated periodically by a multidisciplinary group comprising both academic and community physicians and are widely disseminated to all relevant physicians, surgeons and hospitals throughout the province.…”

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confidence: 99%

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The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

Sawka

Olivotto²,

Coldman³

et al. 1997

Br J Cancer

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C Sawka1 2, 3,4, I Olivotto5,6, A Coldman6,7, V GoeJ3,4,8 Summary This study evaluated the impact of province-wide treatment guidelines on consistency of adjuvant therapy for node-negative breast cancer. A retrospective population-based cohort study was conducted in the Canadian provinces of British Columbia, which has provincewide guidelines, and Ontario, which does not. All eligible 1991 incident cases of node-negative breast cancer in British Columbia (n = 942) and a similar number of randomly selected 1991 incident cases in Ontario (n = 938) were reviewed. Consistency of adjuvant therapy received was evaluated by stratifying cases into discrete diagnostic groups using several grouping systems, and by then comparing the distribution of treatments received within each diagnostic group in the two provinces. Recursive partitioning was also performed. We observed that patterns of pathology reporting were consistent with awareness of the factors used in the British Columbia guidelines to define indications for adjuvant therapy. Consistency of care was greater in British Columbia than in Ontario by all diagnostic grouping systems and by recursive partitioning (P < 0.001), and the observed patterns in British Columbia corresponded to the British Columbia guidelines. We conclude that populationbased treatment guidelines can play a role in promoting consistent patterns of adjuvant therapy for women with node-negative breast cancer.

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confidence: 99%

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confidence: 99%

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

Sawka

Olivotto²,

Coldman³

et al. 1997

Br J Cancer

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“…Neutropenic fever occurred in 96% of patients. Gastrointestinal The ability of adjuvant chemotherapy to improve long-term disease-free and overall survival in patients with breast cancer and tumour-positive axillary lymph nodes is now widely recognised (Early Breast Cancer Trialists' Collaborative Group, 1992;Olivotto et al, 1994). The precise characteristics of patient groups that benefit most from this treatment modality and the optimal type, duration and intensity of chemotherapy, however, continue to be the subjects of intensive research (Fisher et al, 1992).…”

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confidence: 99%

High-dose carboplatin, thiotepa and cyclophosphamide (CTC) with peripheral blood stem cell support in the adjuvant therapy of high-risk breast cancer: a practical approach

Wall

Nooijen²,

Baars³

et al. 1995

Br J Cancer

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Summary In 29 chemotherapy-naive patients with stage II-III breast cancer, peripheral blood stem cells (PBSCs) were mobilised following fluorouracil 500mg m-2, epirubicin 90-120mg m2 and cyclophosphamide 500 mg m-2 (FEC) and granulocyte colony-stimulating factor (G-CSF; Filgrastim) 300 iLg s.c. daily. In all but one patient, mobilisation was successful, requiring three or fewer leucocytopheresis sessions in 26 patients; 28 patients subsequently underwent high-dose chemotherapy consisting of carboplatin 1600 mg m-2, thiotepa 480 mg m-2 and cyclophosphamide 6 g m-2 (CTC) followed by PBSC transplantation. Haemopoietic engraftment was rapid with a median time to neutrophils of 500 x 10 1-' of 9 days (range 8-10) in patients who received G-CSF after PBSC-transplantation; platelet transfusion independence was reached within a median of 10 days (range 7-16). Neutropenic fever occurred in 96% of patients. Gastrointestinal The ability of adjuvant chemotherapy to improve long-term disease-free and overall survival in patients with breast cancer and tumour-positive axillary lymph nodes is now widely recognised (Early Breast Cancer Trialists' Collaborative Group, 1992;Olivotto et al., 1994). The precise characteristics of patient groups that benefit most from this treatment modality and the optimal type, duration and intensity of chemotherapy, however, continue to be the subjects of intensive research (Fisher et al., 1992).One major approach to further improve the results of chemotherapy in breast cancer is dose intensification (Antman, 1992a;Wood et al., 1994). Studies with haematological growth factors such as granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) have shown that the chemotherapy dose per unit of time can be increased by a factor 1.5-2.0 (as compared with 'standard' doses) in young patients with breast cancer (Bronchud et al., 1989;Gianni et al., 1990). At these dose levels, thrombocytopenia and organ toxicity become dose-limiting. In non-randomised studies, this type of intensified chemotherapy typically leads to high response rates in patients with advanced disease, but not to long-term survival. Further dose escalation, beyond the levels achievable with growth factors alone, requires autologous bone marrow stem cell support. In patients with advanced disease, high-dose multiple alkylator chemotherapy may lead to a 17-26% long-term disease-free survival (Livingston, 1994). Subgroup analyses of non-randomised studies suggest that patients who receive high-dose chemotherapy as consolidation treatment in a chemotherapy-induced complete remission may profit most (Klumpp et al., 1994 (Gianni et al., 1992;Mulder et al., 1993; Peters et al., 1993). The largest of these (Peters et al., 1993) reported on 85 patients, who received four cycles of cyclophosphamide, doxorubicin and fluorouracil, followed by a high-dose chemotherapy regimen incorporating cyclophosphamide, cisplatin and BCNU. The relapse-free survival of these patients appears to be markedly im...

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“…Furthermore, LR-free survival was not studied and patients with DCIS were excluded. In the systemic adjuvant treatment of patients with breast cancer, Olivotto et al (1994) demonstrated that improvements in disease-free survival and overall survival, noted during the time period of guideline implementation, were similar to those observed in clinical trials.…”

Section: Discussionmentioning

confidence: 60%

Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ

et al. 2005

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The aim was to study the effect of compliance with guidelines on local recurrence (LR)-free survival in patients treated for ductal carcinoma in situ (DCIS). From January 1992 to December 2003, 251 consecutive patients had been treated for DCIS in two hospitals in the North Netherlands. Every case in this two-hospital sample was reviewed in retrospect for its clinical and pathological parameters. It was determined whether treatment had been carried out according to clinical guidelines, and outcomes in follow-up were assessed. In addition, all patients treated for DCIS in this region (n ¼ 1389) were studied regarding clinical parameters, in order to determine whether the two-hospital sample was representative of the entire region. In the two-hospital sample, 31.4% (n ¼ 79) of the patients had not been treated according to the guidelines. Positive margins were associated with LR (hazard ratio (HR) ¼ 4.790, 95% confidence interval (CI) 1.696 -13.531). Breast-conserving surgery and deviation from the guidelines were independent predictors of LR (HR ¼ 7.842, 95% CI 2.126 -28.926; HR ¼ 2.778, 95% CI 0.982 -6.781, respectively). Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR ¼ 1.254, 95% CI 0.272 -5.776 for time period 1992 -1995 and HR ¼ 1.976, 95% CI 0.526 -7.421 for time period 1996. Clinical guidelines for the treatment of patients with DCIS have been developed and updated from existing literature and best evidence. Compliance with the guidelines was an independent predictor of disease-free survival. These findings support the application of guidelines in the treatment of DCIS.

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Adjuvant Systemic Therapy and Survival after Breast Cancer

Abstract: Survival among women with breast cancer improved significantly in a geographically defined population during the period when adjuvant systemic therapy became widely used.

Cited by 77 publications

References 13 publications

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

High-dose carboplatin, thiotepa and cyclophosphamide (CTC) with peripheral blood stem cell support in the adjuvant therapy of high-risk breast cancer: a practical approach

Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ

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