Toronto Workshop on Late Recurrence in Estrogen Receptor–Positive Breast Cancer: Part 1: Late Recurrence: Current Understanding, Clinical Considerations

Dowling, Ryan J.O.; Kalinsky, Kevin; Hayes, Daniel F.; Bidard, François-Clément; Cescon, David W.; Chandarlapaty, Sarat; Deasy, Joseph O.; Dowsett, Mitch; Gray, Robert J.; Henry, N. Lynn; Meric‐Bernstam, Funda; Perlmutter, Jane; Sledge, George W.; Bratman, Scott V.; Carey, Lisa A.; Chang, Martin C.; DeMichele, Angela; Ennis, Marguerite; Jerzak, Katarzyna J.; Korde, Larissa A.; Lohmann, Ana Elisa; Mamounas, Eleftherios P.; Parulekar, Wendy R.; Regan, Meredith M.; Schramek, Daniel; Stambolic, Vuk; Thorat, Mangesh A.; Whelan, Timothy J.; Wolff, Antonio C.; Woodgett, Jim; Sparano, Joseph A.; Goodwin, Pamela J.

doi:10.1093/jncics/pkz050

Cited by 22 publications

(19 citation statements)

References 70 publications

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“…Therefore, its combination with a multigene assay is important for deciding whether to extend endocrine therapy (17,32). Furthermore, in addition to a clinical calculator, such as CTS5, and a multigene assay, further combination with an immunohistochemistry assay and radiographic imaging (computed tomography, positronemission tomography, and magnetic resonance imaging) or tumor marker assessments is important for predicting patient prognosis (25,33). In conclusion, although CTS5 was created to support decision-making by clinicians about extending adjuvant endocrine therapy in postmenopausal women with positive hormonal receptors, there are limitations in predicting late DR in premenopausal women.…”

Section: Discussionmentioning

confidence: 99%

“…In some patients who underwent CTS5 validation, GenesWell™ BCT also was applied, and the CTS5-derived risk group correlated with the gene assay risk group ( Supplementary Figure 1 ). However, the use of multigene assays is controversial in predicting late DR because some assays have not been validated, and the importance of clinical risk has been emphasized, especially in multigene panels of patients under 50 years of age ( 25 ). In conclusion, balanced application of a clinicopathologic prediction model and a multigene assay should be conducted to predict late DR, and further study is needed for proper selection of patients to receive extended adjuvant endocrine therapy.…”

Section: Discussionmentioning

confidence: 99%

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Validation of the Clinical Treatment Score Post–Five Years in Breast Cancer Patients for Predicting Late Distant Recurrence: A Single-Center Investigation in Korea

Lee

Chae

et al. 2021

Front. Oncol.

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BackgroundEndocrine therapy is administered to hormone-positive breast cancer patients to prevent distant metastasis. It is important to evaluate the risk of recurrence and to determine which patients are viable candidates for such treatment because hormone therapy has side effects that can include postmenopausal symptoms. The Clinical Treatment Score post–five years (CTS5), a simple tool for identifying candidates for endocrine therapy, was recently introduced; however, CTS5 only has been applied in validation studies with postmenopausal women. We aimed to validate CTS5 among premenopausal breast cancer patients.MethodsWe identified patients treated between 1994 and 2014 at Samsung Medical Center in Seoul, Korea, and followed their treatment outcomes for more than 60 months after surgery using clinicopathologic parameters. According to menopausal status, we divided the study population into two groups: pre- and postmenopausal women. After calculating CTS5 values based on some parameters, we stratified the rate of late distant recurrence (DR) and analyzed the correlation between CTS5 value and late DR by risk.ResultsAmong 16,904 patients treated surgically for breast cancer, 2,605 with hormone receptor–positive breast cancer who received endocrine therapy were included. Of these, 1,749 (67.14%) patients were premenopausal women, and the median age was 44.00 years. When categorizing study participants according to CTS5-related risk for late DR, 86.79% were categorized as low risk, 5.95% were categorized as intermediate risk, and 7.26% were categorized as high risk. The annual rate of DR was 1.41% for those in the present study and was similar between pre- and postmenopausal participants (1.40 vs. 1.42). Distant metastasis-free survival was not different between the two groups (hazard ratio: 0.817, 95% confidence interval [CI]: 0.547–1.221). The area under the receiver operating characteristic curve at 10 years for premenopausal and postmenopausal patients was 61.75 (95% CI: 52.97–70.53) and 72.71 (95% CIs: 63.30–82.12), respectively.ConclusionsAlthough CTS5 was able to predict late DR, it should be applied with caution in premenopausal women. A CTS5 calculator for premenopausal women might be needed to not underestimate the risk of recurrence in Korea.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Validation of the Clinical Treatment Score Post–Five Years in Breast Cancer Patients for Predicting Late Distant Recurrence: A Single-Center Investigation in Korea

Lee

Chae

et al. 2021

Front. Oncol.

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“…The two-year time horizon may confer additional limitations. Studies have shown that BC recurrence in estrogen receptor-positive (ER+) BC may have late recurrence [23][24][25]. However, it is rare that recurrence curves would cross over time and therefore it would be unexpected to see drastically different results over longer follow-ups.…”

Section: Limitationsmentioning

confidence: 99%

No increase in incidence or risk of recurrence of breast cancer in ospemifene-treated patients with vulvovaginal atrophy (VVA)

et al. 2020

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To estimate the incidence and recurrence of breast cancer (BC) in patients with vulvovaginal atrophy (VVA) treated with ospemifene and matched untreated VVA patients using real-world data. Study design: Retrospective matched cohort study.Main Outcome Measures: VVA patients were identified from the 2011-2018 US MarketScan® insurance claims database. For incidence, ospemifene-treated VVA patients without evidence of BC prior to index treatment were matched to two untreated VVA controls similarly without history of BC on age, index VVA year, geographic region, Charlson Comorbidity categories, and follow-up time. BC after the index treatment was identified by BC diagnosis codes, mastectomy, chemotherapy, or radiation procedure. Incidence rate, rate ratio (RR) and their 95 % confidence intervals (CI) were calculated. The process was repeated to estimate BC recurrence in patients with a history of BC in 1:1, 1:2 and 1:3 matches. Results: 1728 ospemifene users and 3456 untreated patients met the inclusion and matching criteria for assessing incidence. The average number of days for which ospemifene was supplied was 314 (standard deviation [SD] = 340). Average follow-up time from index treatment was 937 days (SD = 392) for treated patients and 915 days (SD = 396) for controls. BC incidence rates per 1000 person-years was 2.03 (95 % CI: 1.06−3.91) for treated patients and 3.53 (95 % CI: 2.49−4.99) for controls (RR = 0.58, 95 % CI: 0.28−1.21). No difference in recurrence was observed between ospemifene-treated and matched untreated patients. Ten (32.3 %) treated vs. 25 (40.3 %) controls in the 1:2 matched analysis had a recurrence. Conclusion: No differences were observed in the BC incidence and recurrence rates in ospemifene users compared with matched controls.

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“…The subject of late recurrences was addressed in a focused international workshop held in Toronto (ON, Canada), in which several aspects of the question were examined [ 7 , 8 ]. Moreover, at the 2020 San Antonio Breast Cancer Symposium, an oral presentation in an educational session (E53) and a poster (PD9-11) further clarified research topics and clinical goals pursued in this area.…”

Section: Introductionmentioning

confidence: 99%

Late Recurrence in Breast Cancer: To Run after the Oxen or to Try to Close the Barn?

Demicheli

Biganzoli

2021

Cancers

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The problem of late recurrence in breast cancer has recently gained attention and was also addressed in an international workshop held in Toronto (ON, Canada), in which several aspects of the question were examined. This Commentary offers a few considerations, which may be useful for the ongoing investigations. A few premises are discussed: (a) clinical recurrences, especially the late ones, imply periods of tumor dormancy; (b) a structured pattern of distant metastases appearance is detectable in both early and late follow-up times; (c) the current general paradigm underlying neoplastic treatments, i.e., that killing all cancer cells is the only way to control the disease, which is strictly sprouting from the somatic mutation theory, should be re-considered. Finally, a few research approaches are suggested.

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Toronto Workshop on Late Recurrence in Estrogen Receptor–Positive Breast Cancer: Part 1: Late Recurrence: Current Understanding, Clinical Considerations

Cited by 22 publications

References 70 publications

Validation of the Clinical Treatment Score Post–Five Years in Breast Cancer Patients for Predicting Late Distant Recurrence: A Single-Center Investigation in Korea

Validation of the Clinical Treatment Score Post–Five Years in Breast Cancer Patients for Predicting Late Distant Recurrence: A Single-Center Investigation in Korea

No increase in incidence or risk of recurrence of breast cancer in ospemifene-treated patients with vulvovaginal atrophy (VVA)

Late Recurrence in Breast Cancer: To Run after the Oxen or to Try to Close the Barn?

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