Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study

Abstract

BackgroundLuminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision.MethodsIn the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading.ResultsThere has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46–1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45–1.88).ConclusionsThe addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings–that are in line with several publications–should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.

Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study

“…This interpretation of our results is supported by others, who also detected no benefit of adjuvant chemotherapy in luminal A breast cancer patients [7,[26][27][28][29][30]. Is there still a roll for adjuvant chemotherapy in patients with nodal positive luminal A breast cancer?…”

“…However, in contrast to the previously published data by Diessner et al [26], we focused on nodal positive luminal A breast cancer and analysed the groups of 1-3 and more than 3 positive lymph nodes as well as the tumor size. Since it has been hypothesized, that in general larger tumors might be associated with a poorer outcome, small (T1) have been compared with larger tumors (T2) with regard to the subgroup of nodal positive patients with only 1-3 positive lymph nodes.…”

Positive sentinel node in luminal A-like breast cancer patients - implications for adjuvant chemotherapy?

“…It is characterized by a low proliferation rate, a high expression of hormone receptors and a low expression of HER2. Having a low proliferation rate makes this subtype less responsive to chemotherapy and several studies have questioned the benefit of chemotherapy in this patient group [3][4][5]. There is an inverse relationship between chemotherapy responsiveness and estrogen receptor expression as the latter serves as an indirect measure of other biomarkers related to tumor growth [6][7][8].…”

“…However, having 4 LNMs is strongly prognostic of a more advanced and aggressive disease also among ER positive, HER2 negative breast cancer patients with macrometastases in SN [9][10][11]. Studies have shown that high-risk hormone receptor positive breast cancer patients with 4 LNMs benefit from chemotherapy [12][13][14][15][16] although there are also studies which have failed to demonstrate this specifically for luminal A patients [3,4]. A limitation of the studies that did not show a therapeutic benefit for luminal A patients is that they did not primarily focus on patients with 4 LNMs.…”

Effects of different preprocessing algorithms on the prognostic value of breast tumour microscopic images

“…Although the adjuvant systemic therapy is mainly responsible for improvement in overall survival, almost two-thirds of the patients would have survived without it (Berry et al, 2005). Taken together with its harsh toxic side effects, the therapeutic concept for breast cancer has been shifting from 'maximally tolerated' to 'minimally necessary treatment' (Jackisch et al, 2015;Diessner et al, 2016). Such treatment optimisation may be achieved by a reliable disease outcome prognosis which could allow personalised administration of systemic therapy only to those patients which are certain to benefit.…”