Optimal timing of adjuvant treatment in patients with early breast cancer

Alkış, Necati; Durnalı, Ayşe; Arslan, Ulku Yalcintas; Koçer, Murat; Onder, Oguz; Tokluoğlu, Saadet; Celenkoglu, Gokhan; Muallaoğlu, Sadık; Utkan, Güngör; Ulaş, Arife; Altundağ, Kadri̇

doi:10.1007/s12032-010-9566-4

Cited by 20 publications

(22 citation statements)

References 17 publications

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“…In breast cancer, several studies have discussed early or delayed adjuvant chemotherapy but have used different cutoff times. Alkis et al [11] set the cutoff time at 45 days, Pronzato et al [12] set it at 35 days, and Colleoni et al [13] set it at 21 days. In spite of different cutoff times, the conclusions were similar; earlier administration was associated with significant survival benefit as compared to delayed administration.…”

Section: Discussionmentioning

confidence: 99%

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Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer

et al. 2016

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Background and ObjectivesComplete surgical resection is recommended for early stage lung cancer, and adjuvant chemotherapy is given for stage IB to IIIA disease. No studies have examined the best timing to administer chemotherapy after surgery in lung cancer. This study was to investigate the optimal timing of adjuvant chemotherapy after surgical resection.MethodsData collected from the Taiwan National Health Insurance Research Database between January, 2004 and December, 2010 were retrospectively analyzed. Patients with stage IB to IIIA lung cancer underwent complete surgical resection and adjuvant chemotherapy were included. A total of 1522 patients were included. The patients were divided into 4 groups according to the interval between surgery and chemotherapy: group 1, < 30 days; group 2, 30–45 days; group 3, 46–60 days; group 4 > 60 days. Univariate and multivariate regression analyses were used to identify prognostic factors for overall survival.ResultsThe numbers of patients in groups 1, 2, 3, and 4 were 153, 161, 290, and 818, respectively. The 5-year survival rate was 41% in group 1, 48% in group 2, 50% in group 3, and 35% in group 4 (p<0.001). The median survival time was 44.50 months in group 1, 59.53 months in group 2, 67.33 months in group 3 and 36.33 months in group 4 (p<0.001) Survival rate is the poorest when chemotherapy is delayed beyond 60 days after surgical resection Multivariate analysis also indicated the interval between surgery and first course of chemotherapy more than 60 days after surgery was an independent risk factor for survival.ConclusionsTiming of chemotherapy after surgery is associated with poorer survival in lung cancer patients.

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Section: Discussionmentioning

confidence: 99%

“…In other cancers, such as breast cancer or colorectal cancer, several studies have examined the timing of adjuvant chemotherapy after surgery [11–19]. These studies have suggested that a delay in administering adjuvant chemotherapy may worsen overall survival.…”

Section: Introductionmentioning

confidence: 99%

Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer

et al. 2016

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“…Breast cancer is one of the most common malignancies and leading causes of cancer-associated mortalities among females (1). Based on DNA microarray techniques, breast cancer is classified into five subtypes: Luminal A; luminal B; normal breast-like; human epidermal growth factor receptor 2 (HER2/neu) overexpressing; and basal-like (2).…”

Section: Introductionmentioning

confidence: 99%

Prognostic analysis of triple-negative breast cancer patients treated with adjuvant chemotherapy of fluorouracil, epirubicin and cyclophosphamide

Sun

Liu

et al. 2016

Oncology Letters

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Abstract. The aim of the present study was to investigate the association between the clinicopathological and demographic factors, and the survival time of patients with triple-negative breast cancer (TNBC) in China. The patients had received adjuvant chemotherapy consisting of 5-fluorouracil, epirubicin and cyclophosphamide (FEC; 500 mg/m 2 cyclophosphamide, day 1; 75 mg/m 2 epirubicin, day 1; 500 mg/m 2 5-fluorouracil, days 1 and 8; every 3 weeks, for at least 4 cycles). The clinicopathological and demographic factors affecting the outcome of the patients with TNBC that received adjuvant FEC chemotherapy were evaluated. Within these variables, the overall survival (OS) and disease-free survival (DFS) times were analyzed using the log-rank test, which was constructed using the multivariate Cox proportional hazards regression model and Kaplan-Meier analysis. Additionally, Spearman's χ 2 test was used to analyze categorical variables. In the univariate statistical analysis, the significant risk factors for TNBC patient survival were the stage of disease and lymph node status, which were associated with the OS and DFS, and the total number of pregnancies, which was associated with the DFS. In the multivariate Cox proportional hazard model, lymph node status was an independent prognostic indicator of OS [P<0.001; hazard ratio (HR), 1.996; 95% confidence interval (CI), 1.465-2.720] and DFS (P<0.001; HR, 1.824; 95% CI, 1.315-2.531). By the Kaplan-Meier method, the stage of disease and lymph node status demonstrated a significant effect on OS and DFS. Patients with the lymph node status N3 and stage III disease possessed a poor prognosis and survival. An association between lymph node status and the tumor recurrence and mortality rate was identified. The area under the curves of the lymph node status for TNBC recurrence and mortality were 0.676 (P=0.002) and 0.685 (P=0.001), respectively. Additionally, the number of pregnancies was associated with tumor size, lymph node status and stages of disease. Lymph node status is an independent prognostic indicator of OS and DFS to TNBC patients with FEC adjuvant chemotherapy. IntroductionBreast cancer is one of the most common malignancies and leading causes of cancer-associated mortalities among females (1). Based on DNA microarray techniques, breast cancer is classified into five subtypes: Luminal A; luminal B; normal breast-like; human epidermal growth factor receptor 2 (HER2/neu) overexpressing; and basal-like (2). The subtype that is immunohistochemically characterized by the lack of expression of the estrogen receptor (ER), progesterone receptor (PR) and HER2 is defined as triple negative breast cancer (TNBC) (3).TNBC, which accounts for 10-15% of breast cancers, is considered to exhibit an aggressive clinical behavior and poor prognosis, due to the insensitivity of the cancer to endocrine and targeted therapy (4-12). Therefore, chemotherapy is a significant therapy for such cancers. The treatment options for TNBC include anthracyclines, taxanes, platinum and alkylating ...

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“…2–7 Several studies have demonstrated early initiation of adjuvant CT is associated with improved survival for colorectal 13–17 and breast cancers. 18–20 Murakami et al 3 reported starting adjuvant CT within 20 days of pancreatic resection improves 5-year OS (52 vs. 26 %; p = 0.013) and 5-year disease-free survival (53 vs. 22 %; p = 0.007).…”

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confidence: 99%

The Impact of Postoperative Complications on the Administration of Adjuvant Therapy Following Pancreaticoduodenectomy for Adenocarcinoma

et al. 2014

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Background The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy (PD) for adenocarcinoma is still unclear. Methods A retrospective review of all patients undergoing PD at our institution between 1995 and 2011 was performed. Clinicopathological data, including Clavien–Dindo complication grade, time to adjuvant therapy (TTA), and survival, were analyzed. Results A total of 1,144 patients underwent PD for adenocarcinoma between 1995 and 2011. The overall complication rate was 49.1 % and clinically severe complications (≥IIIb) occurred in 4.2 %. Overall, 621 patients (54.3 %) were known to have received adjuvant therapy. The median TTA was 60 days. Although the presence of a complication was associated with a delay in TTA (p = 0.002), the grade of complication was not (p = 0.112). On multivariate analysis, only age > 68 years (p < 0.001) and length of stay >9 days (p = 0.002) correlated with no adjuvant therapy. Patients with postoperative complications were more likely to receive single adjuvant chemotherapy or radiation therapy (31.4 %) than were patients without complications (17.1 %; p < 0.001). Patients without a complication had a longer median survival compared with patients who experienced complications (19.5 vs. 16.1 months; p = 0.001). Patients without complications who received adjuvant therapy had longer median survival than patients with complications who received no adjuvant therapy (22.5 vs. 10.7 months; p < 0.001). Multivariate analysis demonstrated that complications [hazard ratio (HR) 1.16; p = 0.023] and adjuvant therapy (HR 0.67; p <0.001) were related to survival. Conclusion Complications and no adjuvant therapy are common following PD for adenocarcinoma. Postoperative complications delay TTA and reduce the likelihood of multimodality adjuvant therapy. Identifying patients at increased risk for complications and those unlikely to receive adjuvant therapy warrants further investigation as they may benefit from a neoadjuvant approach.

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Optimal timing of adjuvant treatment in patients with early breast cancer

Cited by 20 publications

References 17 publications

Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer

Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer

Prognostic analysis of triple-negative breast cancer patients treated with adjuvant chemotherapy of fluorouracil, epirubicin and cyclophosphamide

The Impact of Postoperative Complications on the Administration of Adjuvant Therapy Following Pancreaticoduodenectomy for Adenocarcinoma

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