ESO–ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4)

Paluch‐Shimon, Shani; Cardoso, Fátima; Partridge, Ann H.; Abulkhair, Omalkhair; Azim, Hatem A.; Bianchi-Micheli, G.; Cardoso, M.J.; Curigliano, Giuseppe; Gelmon, Karen A.; Harbeck, Nadia; Merschdorf, J.; Poortmans, Philip; Pruneri, Giancarlo; Senkus, Elżbieta; Španić, Tanja; Stearns, Vered; Wengström, Yvonne; Peccatori, Fedro Alessandro; Pagani, Olivia

doi:10.1016/j.annonc.2020.03.284

Cited by 195 publications

(262 citation statements)

References 208 publications

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“…Our present results are in accordance with prior studies, confirming that pregnancy itself does not seem to influence breast cancer outcome, with the therapeutic approach being similar between PABC and BC in non-pregnant patients, according to the disease type and stage [ 60 ]. All infants exhibited healthy development, and no cardiac side effects from chemotherapy were reported for either the mothers or infants.…”

Section: Discussionsupporting

confidence: 92%

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

et al. 2020

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Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers.

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Section: Discussionsupporting

confidence: 92%

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

et al. 2020

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“…Furthermore, the benefit of chemotherapy in the high-intermediate risk category (i.e., [16][17][18][19][20][21][22][23][24][25] was only observed in patients aged 41-45 years and premenopausal patients between 46 and 50 years but not in the group aged ≤40 years 25 . This observation is hard to reconcile especially in light of the trial by Poorvu et al 21 who did not observe a benefit from chemotherapy use in terms of DRFS at 6 years for YWBC with an intermediate risk for recurrence (i.e., [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. On the other hand, in the MINDACT trial patients aged ≤50 years with CH/GL risk appeared to derive more benefit of chemotherapy 28,45 , which was also different to the main results taking into account data from all patients 26 .…”

Section: Discussionmentioning

confidence: 97%

“…Other noteworthy analyses of prognostic value of Oncotype DX in YWBC include Harbeck et al 24 who demonstrated that patients aged <40 years with a high recurrence score using the TAILORx threshold (i.e., >25) had a similar DFS than their older counterparts when treated with chemotherapy, and Sparano et al 25 who showed that patients aged ≤40 years who had high-intermediate risk scores (i.e., [16][17][18][19][20][21][22][23][24][25] did not benefit from chemotherapy addition in terms of DFS.…”

Section: Impact Of Age On the Decision To Perform Genomic Testsmentioning

confidence: 99%

“…Lastly, Barcenas et al 33 conducted a single center retrospective analysis on patients with stage I-II, hormone-receptor-positive/ HER2-negative, N0 disease who had an Oncotype DX test performed. Among patients with an intermediate score according to TAILORx thresholds (i.e., [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], it was found that patients who were treated with chemotherapy were younger (38% of patients aged ≤40 years received chemotherapy vs. 15% of their older counterparts), had larger tumors and a higher clinical stage.…”

Section: Endopredictmentioning

confidence: 99%

“…In the past decade, risk stratification by gene expression signatures has been endorsed by international guidelines to improve prognostication and guide treatment decisions among women with hormone-receptor positive breast cancer [17][18][19] . Most of these genomic signatures are commercially available, including: Oncotype DX, MammaPrint, EndoPredict, Prosigna, Breast Cancer Index (BCI), and Genomic Grade Index (GGI).…”

Section: Introductionmentioning

confidence: 99%

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Clinical utility of genomic signatures in young breast cancer patients: a systematic review

et al. 2020

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Risk stratification by genomic signatures has been shown to improve prognostication and guide treatment decisions among patients with hormone-sensitive breast cancer. However, their role in young women has not been fully elucidated. In this review, a systematic search was conducted for published articles and abstracts from major congresses that evaluated the use of genomic signatures in young breast cancer patients. A total of 71 studies were analyzed, including 561,188 patients of whom 27,748 (4.9%) were young. Women aged ≤40 years were subjected to genomic testing at a similar rate to older women but had a higher proportion of intermediate- to high-risk tumors when classified by EndoPredict (p = 0.04), MammaPrint (p < 0.01), and Oncotype DX (p < 0.01). In young women with low genomic risk, 6-year distant recurrence-free survival was 94%, while 5-year overall survival was nearly 100%. Nonetheless, young patients classified as low-risk had a higher tendency to receive chemotherapy compared to their older counterparts. In conclusion, genomic tests are useful tools for identifying young patients in whom chemotherapy omission is appropriate.

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Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer

Kabirian,

Franzoi,

Havas

et al. 2023

JAMA Netw Open

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ImportanceYounger survivors of breast cancer frequently report more treatment-related symptoms, mostly related to the menopausal transition.ObjectiveTo assess factors associated with chemotherapy-related amenorrhea (CRA) and to evaluate its association with long-term quality of life (QOL).Design, Setting, and ParticipantsThe prospective, longitudinal Cancer Toxicities Study, a multicenter French cohort study, includes women with a diagnosis of stage I to III breast cancer and collects data approximately yearly after diagnosis. The current study reports outcomes up to 4 years after diagnosis for participants enrolled from 2012 to 2017. Participants included premenopausal women younger than 50 years treated with chemotherapy and not receiving adjuvant ovarian function suppression. Data analysis was performed from September 2021 to June 2023.ExposuresClinical, socioeconomic, tumor, and treatment characteristics assessed at diagnosis (for the analysis of factors associated with CRA) and persistent CRA (for the QOL analysis).Main Outcomes and MeasuresThe main outcome of interest was CRA at year 1 (Y1), year 2 (Y2), and year 4 (Y4) after diagnosis. Generalized estimating equations assessed associations of exposure variables with CRA. In the QOL analysis, QOL at Y4 (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23) was the outcome of interest. Multivariable random-effect mixed models assessed the association of persistent CRA (ie, never recovering menses after treatment) with QOL.ResultsAmong 1636 women, the mean (SD) age at diagnosis was 42.2 (5.6) years. Overall, 1242 of 1497 women (83.0%) reported CRA at Y1, 959 of 1323 women (72.5%) reported it at Y2, and 599 of 906 women (66.1%) reported it at Y4. Older age vs 18 to 34 years (adjusted odds ratio [OR] for 35 to 39 years, 1.84 [95% CI, 1.32 to 2.56]; adjusted OR for 40 to 44 years, 5.90 [95% CI, 4.23 to 8.24]; and adjusted OR for ≥45 years, 21.29 [95% CI, 14.34 to 31.61]) and receipt of adjuvant tamoxifen (adjusted OR, 1.97 [95% CI, 1.53 to 2.53]) were associated with higher likelihood of CRA. In the QOL analysis, 416 of 729 women (57.1%) had persistent CRA. However, late menses recovery among women aged 18 to 34 years with no menses at Y2 were reported by 11 of 21 women (52.4%) between Y2 and Y4. Persistent CRA was associated with worse insomnia (mean difference vs recovery at any time, 9.9 points [95% CI, 3.2 to 16.5 points]; P = .004), systemic therapy–related adverse effects (mean difference, 3.0 points [95% CI, 0.2 to 5.8 points]; P = .04), and sexual functioning (mean difference, −9.2 points [95% CI, −14.3 to −4.1 points]; P &lt; .001) at Y4.Conclusions and RelevanceIn this cohort study of premenopausal women with breast cancer, persistent CRA was common, although some women recovered menses late, and was associated with worse long-term QOL. This study can help inform risk communication, personalized counseling, and early supportive care referrals for such patients.

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ESO–ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4)

Cited by 195 publications

References 208 publications

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

Clinical utility of genomic signatures in young breast cancer patients: a systematic review

Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer

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