Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer

Farolfi, Alberto; Scarpi, Emanuela; Rocca, Andrea; Mangia, Anita; Biglia, Nicoletta; Giannì, L.; Tienghi, A.; Valerio, Maria Rosaria; Gasparini, Giampietro; Amaducci, Laura; Faedi, Marina; Baldini, Editta; Rubagotti, Alessandra; Maltoni, Roberta; Paradiso, Angelo; Amadori, Dino

doi:10.1016/j.ejca.2015.07.003

Cited by 22 publications

(19 citation statements)

References 19 publications

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“…Time to adjuvant chemotherapy was analysed with three different cut‐off values: within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. These cut‐offs were chosen based on the currently recommended starting point according to Dutch and ESMO guidelines, and on previous literature demonstrating that a clinical impact is found when adjuvant chemotherapy is started later than 7–12 weeks, indicating the importance of initiating adjuvant chemotherapy at least within this time period.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have reported that delayed initiation of adjuvant chemotherapy is associated with lower overall and recurrence‐free survival. The recommended acceptable maximum delay, however, varies from 7 to 12 weeks.…”

Section: Introductionmentioning

confidence: 99%

“…The recommended acceptable maximum delay, however, varies from 7 to 12 weeks. There still is no international consensus on the definition of an unacceptable delay, but all guidelines advocate that initiation of adjuvant chemotherapy should not be delayed unnecessarily, as this may have a negative impact on survival, specifically in patients at higher risk of recurrence.…”

Section: Introductionmentioning

confidence: 99%

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Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Heeg

Harmeling

Becherer

et al. 2019

British Journal of Surgery

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Background: Initiation of adjuvant chemotherapy within 6-12 weeks after mastectomy is recommended by guidelines. The aim of this population-based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy.Methods: All patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias.Results: A total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27⋅0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0⋅76, 95 per cent c.i. 0⋅66 to 0⋅87) and 9 weeks (0⋅69, 0⋅54 to 0⋅87), but not within 12 weeks (OR 0⋅75, 0⋅48 to 1⋅17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0⋅95, 0⋅90 to 0⋅99), but not within 9 weeks (OR 0⋅97, 0⋅95 to 1⋅00) or 12 weeks (OR 1⋅00, 0⋅99 to 1⋅01).Conclusion: Postmastectomy IBR marginally reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Thus, IBR is not contraindicated in patients who need adjuvant chemotherapy after mastectomy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Heeg

Harmeling

Becherer

et al. 2019

British Journal of Surgery

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“…However, theoretically, micrometastatic deposits are eliminated more effectively with earlier chemotherapy administration, thereby reducing early recurrence [12]. Moreover, there is evidence that early adjuvant treatment initiation leads to superior survival rates for patients with breast [13, 14], colorectal [15–17], and pancreatic cancer [12, 18]. Thus, the National Comprehensive Cancer Network (NCCN) guidelines state that chemotherapy should be initiated for all patients who underwent curative resection, but they do not specify the optimal start time for chemotherapy or whether it should be delayed until full recovery [19].…”

Section: Introductionmentioning

confidence: 99%

Early versus delayed initiation of adjuvant treatment for pancreatic cancer

et al. 2017

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BackgroundPancreatic ductal adenocarcinoma (PDAC) is a highly aggressive tumor showing a tendency for early recurrence, even after curative resection. Although adjuvant treatment improves survival, it is unclear whether early adjuvant treatment initiation yields better outcomes in patients with PDAC.MethodsWe retrospectively enrolled 113 patients who underwent chemotherapy or chemoradiotherapy after curative resection of PDAC: Fifty-six and 57 patients were in the early and delayed groups, respectively based on the median time of treatment initiation (35 days [range, 20–83 days]).ResultsPatient baseline characteristics were comparable in both groups, except for grade III or IV postoperative complications (5.4% in the early group vs. 22.8% in the delayed group). With a median 20.3-month follow-up, the overall survival (OS) and disease-free survival (DFS) times were 29.5 and 14.7 months, respectively. The early group had significantly prolonged OS (39.1 vs. 21.1 months, p = 0.018) and DFS (18.8 vs. 10.0 months, p = 0.034), compared to the delayed group. Among 71 patients who completed planned adjuvant treatment, patients in the early group tended to have longer, though not statistically significant, OS and DFS times than those in the delayed group. In 67 patients without postoperative complications, patients in the early group had longer OS (42.8 vs. 20.5 months, p = 0.002) and DFS (19.6 vs. 9.1 months, p = 0.005) than those in the delayed group. By multivariate analysis, incompletion of treatment (hazard ratio [HR]: 4.039, 95% confidence interval [CI]: 2.334–6.992), delayed treatment initiation (HR: 1.822, 95% CI: 1.081–3.070), and positive angiolymphatic invasion (HR: 2.116, 95% CI: 1.160–3.862) were significantly associated with shorter OS.ConclusionsAdjuvant treatment should be delivered earlier and completed for better outcomes in resected PDAC patients, especially without postoperative complications.

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“…Relatos da associação entre altos índices de mortalidade, diagnóstico tardio e assistência médica incipiente, têm sido amplamente divulgados e parecem ser frequentes nos países em desenvolvimento. [7][8][9] Este cenário hodierno se reflete no Brasil, onde a estimativa de novos casos de câncer de mama se assemelha a países de baixo desenvolvimento. 10 Apenas para o ano de 2015 foi estimado o risco de 56,09 casos a cada 100 mil mulheres, e na região sudeste, uma das áreas mais desenvolvidas do país, embora o número de mortes por esta neoplasia tenha se estabilizado, a alta incidência ainda é um fator preocupante.…”

Section: Introductionunclassified