Does Timing of Adjuvant Chemotherapy for Early Breast Cancer Influence Survival?

Abstract

D o e s T i m i n g o f A d j u v a n t C h e m o t h e r a p y f o r E a r l y B r e a s t C a n c e r I n fl u e n c e S u r v i v a l ?By C. Shannon, S. Ashley, and I.E. SmithPurpose: 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 1,161 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 > 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.

Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women

“…The International Breast Cancer Study Group reported a 40% improvement in survival in pre-menopausal, lymph-node positive, hormone receptor negative women who initiated chemotherapy within 3 weeks of their primary surgery compared to women who started between 3 and 12 weeks [8]. However, both the Danish Breast Cancer Cooperative Group and the Royal Marsden Hospital failed to confirm those findings, and found no benefit for early treatment initiation [9,10]. Our study found no survival benefit from earlier initiation of chemotherapy.…”

“…The International Breast Cancer Study Group reported a 40% survival benefit for pre-menopausal, lymph-node positive, hormone receptor negative women with breast cancer who initiated chemotherapy within 3 weeks of their primary surgery, compared to women who started chemotherapy between 3 and 12 weeks [8]. On the other hand, both the Danish Breast Cancer Cooperative Group and the Royal Marsden Hospital failed to confirm those findings, and found no benefit for early treatment initiation [9,10]. These prior studies of the interval between primary surgery for breast cancer and the subsequent initiation of adjuvant chemotherapy were limited to the select group of patients who were entered on clinical trials [8,9,11,12].…”

“…On the other hand, both the Danish Breast Cancer Cooperative Group and the Royal Marsden Hospital failed to confirm those findings, and found no benefit for early treatment initiation [9,10]. These prior studies of the interval between primary surgery for breast cancer and the subsequent initiation of adjuvant chemotherapy were limited to the select group of patients who were entered on clinical trials [8,9,11,12].…”

Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival

“…Elderly patients with early-stage breast cancer appeared to derive no benefit from early initiation of chemotherapy, but long treatment initiation delays were associated with increased mortality (Hershman et al, 2006b). Other adjuvant breast cancer trials have also failed to detect a benefit from early initiation of therapy (Shannon et al, 2003;Cold et al, 2005). Our group recently reported the effect of treatment delay in patients with stage III colon cancer.…”

Análise do atraso no diagnóstico e tratamento do câncer de mama em um hospital público

“…Vale ressaltar que este é um ponto de corte arbitrário e o intervalo ideal para se iniciar a terapia adjuvante é desconhecido. Vários estudos mostraram resultados controversos quanto ao impacto do intervalo entre a cirurgia e a instituição do tratamento na sobrevida global dos doentes com câncer 23,24 . Do ponto de vista de importância clínica dos diferentes atrasos, os três intervalos mais importantes, em ordem decrescente de gravidade, são: mamografia -biópsia, resultado da biópsia -cirurgia, resultado do exame anatomopatológico -tratamento adjuvante.…”