Persistent impairments 3 years after (neo)adjuvant chemotherapy for breast cancer: results from the MaTox project

Abstract

PurposeAlthough treatment for early breast cancer improved prognosis greatly, it can have significant long-term consequences, which must be considered during treatment decision.Methods453 patients with neoadjuvant or adjuvant treatment intention were recruited into the MaTox project within the prospective, multicentre, population-based German TMK cohort study (Tumour Registry Breast Cancer) between 2008 and 2009. Patient-reported outcomes (PROs) on 26 treatment-related symptoms were assessed via a specifically designed questionnaire at 4 weeks, 6 months, 18 months and 3 years after start of systemic treatment.ResultsThe results show that alterations in smell, taste and appetite were clearly improved 3 years after treatment. In contrast, post-surgical symptoms, restrictions in memory/attention, musculoskeletal system and polyneuropathy worsened substantially over time and were persistent after 3 years: 78% of the patients recorded impairment in memory, 73% muscle pain, 67% pain at the operated site and 57% paraesthesia in fingers or toes. A logistic regression model showed that risk factors for developing persistent paraesthesia symptoms were age, early paraesthesia symptoms and taxane-based therapy.ConclusionsOur data show that most patients with breast cancer have persistent impairments negatively influencing their daily life even 3 years after treatment. Furthermore, we highlight areas requiring special attention in follow-up care.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-017-4365-7) contains supplementary material, which is available to authorized users.

Quality of life in pre- and postmenopausal patients with early breast cancer: a comprehensive analysis from the prospective MaLife project

“…Another aspect that needs to be addressed in follow-up care is neurotoxicity. The main symptom of neurotoxicity is peripheral neuropathy, associated with paraesthesia and numbness of fingers and toes, which is known to persist for years [ 15 , 44 – 46 ]. Indeed, 55–56% of the patients in the MaLife cohort reported a clinically meaningful worsening of taxane-related toxicity 3 years after start of treatment, confirming the persistence of symptoms.…”

“…Although recent findings suggest that endocrine therapy alone is adequate for women with low-risk tumours [ 8 , 9 ], additional adjuvant chemotherapy is widely used. Both systemic treatment options are associated with side effects and toxicities: while endocrine therapy may cause osteopenia, osteoporosis, arthralgia, musculoskeletal symptoms and menopausal complaints [ 10 – 14 ]; chemotherapy is associated with nausea, hair loss, paraesthesia, neuropathy and cardiotoxicity, some of which are persistent even years after treatment [ 15 – 17 ]. Furthermore, crucial side effects for premenopausal patients are treatment-induced amenorrhea or infertility [ 18 – 21 ].…”

“…The clinical cohort study TMK (Tumour Registry Breast Cancer) set out to examine the treatment of early and metastatic breast cancer in German routine care as well as the impact of the disease on various aspects of life. For patients with early breast cancer, we previously published data on the routine treatment with adjuvant chemotherapy [ 24 ] and results from the MaTox project on toxicity-related symptoms after adjuvant chemotherapy [ 15 ]. In the analysis at hand, we present data from the longitudinal MaLife project—a comprehensive assessment of PROs in a real-world setting, aiming to get a detailed understanding of the situation of patients with breast cancer in German routine care.…”

Phase 2 Study of Dose-Dense Doxorubicin and Cyclophosphamide Followed by Eribulin Mesylate With or Without Prophylactic Growth Factor for Adjuvant Treatment of Early-Stage Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer

“…26 Although the patient number in this study is small, grade 3-4 peripheral neuropathy occurred in 1% of total patients, which is thought provoking in the setting of adjuvant breast cancer therapy where neuropathy may have long term impact on quality of life. 27 Previous data have suggested that taxane therapy in the adjuvant treatment of breast cancer, is associated with grade 3-4 peripheral neuropathy rates of 6-10%. 28,29 As of data cutoff (28 Apr 2015), the 3-year DFS rate and the 3-year overall survival rate for all patients was 89.5% and 97.1% respectively.…”

Artificial intelligence applications for oncological positron emission tomography imaging

“…Still, balanced data is needed to further validate the confidence of the model. Selected patients may avoid toxic and side effect as well as economic burden caused by neoadjuvant chemotherapy (NAC) if we can predict the patients' response to NAC [50,51]. Antunovic et al created multiple logistic regression models and demonstrated that in breast cancer patients who underwent 18 F-FDG PET/CT, the patients with triple-negative and HER2+ had a higher rate of pathologic complete response (pCR) to NAC than those with luminal [52].…”