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Vliek SB, Hilbers FS, Jager A, Retèl VP, Bueno de Mesquita JM, Drukker CA, Veltkamp SC, Zeillemaker AM, Rutgers EJ, van Tinteren H, van Harten WH, van 't Veer LJ, van de Vijver MJ, Linn SC. Ten-year follow-up of the observational RASTER study, prospective evaluation of the 70-gene signature in ER-positive, HER2-negative, node-negative, early breast cancer. Eur J Cancer 2022; 175:169-179. [PMID: 36126477 DOI: 10.1016/j.ejca.2022.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Prognostic gene expression signatures can be used in combination with classical clinicopathological factors to guide adjuvant chemotherapy decisions in ER-positive, HER2-negative breast cancer. However, long-term outcome data after introduction of genomic testing in the treatment decision-making process are limited. METHODS In the prospective RASTER study, the tumours of 427 patients with cTanyN0M0 breast cancer were tested to assess the 70-gene signature (MammaPrint). The results were provided to their treating physician to be incorporated in the decision-making on adjuvant systemic therapy. Here, we report the long-term outcome of the 310 patients with ER-positive, HER2-negative tumours by clinical and genomic risk categories at a median follow-up of 10.3 years. RESULTS Among the clinically high-risk patients, 45 (49%) were classified as genomically low risk. In this subgroup, at 10 years, distant recurrence free interval (DRFI) was similar between patients treated with (95.7% [95% CI 87.7-100]) and without (95.5% [95% CI 87.1-100]) chemotherapy. Within the group of clinically low-risk patients, 56 (26%) were classified as genomically high risk. Within the clinically low-risk group, beyond 5 years, a difference emerged between the genomically high- and low-risk subgroup resulting in a 10-year DRFI of 84.3% (95% CI 74.8-95.0) and 93.4% (95% CI 89.5-97.5), respectively. Interestingly, genomic ultralow-risk patients have a 10-year DRFI of 96.7% (95% CI 90.5-100), largely (79%) without systemic therapy. CONCLUSIONS These data confirm that clinically high-risk, genomically low-risk tumours have an excellent outcome in the real-world setting of shared decision-making. Together with the updated results of the MINDACT trial, these data support the use of the MammaPrint, in ER-positive, HER2-negative, node-negative, clinically high-risk breast cancer patients. REGISTRY ISRCTN71917916.
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Affiliation(s)
- Sonja B Vliek
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Florentine S Hilbers
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Valesca P Retèl
- Departmentment of Psycosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Jolien M Bueno de Mesquita
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Addiction Medicin & Psychiatry, Brijder/Parnassia Group, The Hague, the Netherlands
| | - Caroline A Drukker
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sanne C Veltkamp
- Department of Surgery, Amstelland Ziekenhuis, Amstelveen, the Netherlands
| | - Anneke M Zeillemaker
- Department of Surgical Oncology, Alrijne Ziekenhuis, Leiderdorp, the Netherlands
| | - Emiel J Rutgers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harm van Tinteren
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, Netherlands; Trial and Data Center, Princes Maxima Centrum, Utrecht, the Netherlands
| | - Wim H van Harten
- Departmentment of Psycosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Laura J van 't Veer
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | - Marc J van de Vijver
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sabine C Linn
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Combining method of detection and 70-gene signature for enhanced prognostication of breast cancer. Breast Cancer Res Treat 2021; 189:399-410. [PMID: 34191200 DOI: 10.1007/s10549-021-06315-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Studies have shown that screen detection by national screening programs is independently associated with better prognosis of breast cancer. The aim of this study is to evaluate the association between tumor biology according to the 70-gene signature (70-GS) and survival of patients with screen-detected and interval breast cancers. METHODS All Dutch breast cancer patients enrolled in the MINDACT trial (EORTC-10041/BIG3-04) accrued 2007-2011, who participated in the national screening program (biennial screening, ages 50-75) were included (n = 1102). Distant Metastasis-Free Interval (DMFI) was evaluated according to the 70-GS for patients with screen-detected (n = 754) and interval cancers (n = 348). RESULTS Patients with screen-detected cancers had 8-year DMFI rates of 98.2% for 70-GS ultralow-, 94.6% for low-, and 93.8% for high-risk tumors (p = 0.4). For interval cancers, there was a significantly lower 8-year DMFI rate for patients with 70-GS high-risk tumors (85.2%) compared to low- (92.2%) and ultralow-risk tumors (97.4%, p = 0.0023). Among patients with 70-GS high-risk tumors, a significant difference in 8-year DMFI rate was observed between interval (85.2%, n = 166) versus screen-detected cancers (93.8%, n = 238; p = 0.002) with a HR of 2.3 (95%CI 1.2-4.4, p = 0.010) adjusted for clinical-pathological characteristics and adjuvant systemic treatment. CONCLUSION Among patients with 70-GS high-risk tumors, a significant difference in DMFI was observed between screen-detected and interval cancers, suggesting that method of detection is an additional prognostic factor in this subgroup and should be taken into account when deciding on adjuvant treatment strategies.
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Schreuder K, Kuijer A, Bentum S, van Dalen T, Siesling S. Use and Impact of the 21-Gene Recurrence Score in Relation to the Clinical Risk of Developing Metastases in Early Breast Cancer Patients in the Netherlands. Public Health Genomics 2019; 21:85-92. [PMID: 30650410 DOI: 10.1159/000495742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The nationwide use of the 21-gene recurrence score (21-RS) and implications regarding chemotherapy administration in relation to clinical risk in early breast cancer patients are investigated. METHODS Breast cancer patients surgically treated between 2014 and 2016 were selected from the Netherlands Cancer Registry and categorized as having a clinical low, intermediate, or high risk of developing metastases. Deployment of the 21-RS is advocated in patients with an intermediate risk of developing metastases. The use and impact of the 21-RS test result on chemotherapy administration were assessed in relation to the clinical risk as well as patient and tumor characteristics; χ2 tests were used for analysis. RESULTS Of all patients, 20,488 were considered as clinical low-, 4,309 as intermediate-, and 15,266 as high-risk patients. The 21-RS was deployed in 0.1% (n = 23), 3.2% (n = 137), and 0.6% (n = 90) of these categories, respectively. In the clinical intermediate-risk group, the 21-RS assigned 73.7, 13.1, and 13.1% of patients to the genomic low-, intermediate-, and high-risk category, respectively. Adherence to the 21-RS was 95.6% in these patients. CONCLUSION In the Netherlands, the 21-RS test is applied both inside and outside the guideline-directed area. In case of discordance between the genomic and clinical risk, patients were treated in line with the result of the 21-RS.
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Affiliation(s)
- Kay Schreuder
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands, .,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands,
| | - Anne Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sanne Bentum
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Schreuder K, Kuijer A, Rutgers EJT, Smorenburg CH, van Dalen T, Siesling S. Impact of gene-expression profiling in patients with early breast cancer when applied outside the guideline directed indication area. Eur J Cancer 2017; 84:270-277. [PMID: 28844015 DOI: 10.1016/j.ejca.2017.07.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In Dutch guidelines, gene expression profiles (GEP) are indicated in estrogen receptor positive early breast cancer patients in whom benefit of chemotherapy (CT) is uncertain based on traditional prognostic factors alone. Aim of the present study is to assess the use and impact of GEP on administration of adjuvant CT in breast cancer patients who have according to national guidelines a clear indication to either use or withhold adjuvant chemotherapy (clinical high or low risk). METHODS Clinical low- and high-risk patients, according to Dutch breast cancer guidelines, diagnosed between 2011 and 2014 were selected from the Netherlands Cancer Registry. Influence of GEP use and GEP test result on CT administration was assessed with logistic regression. RESULTS Overall, 26,425 patients were identified; 4.8% of patients with clinical low risk (444/9354), 7.5% of the patients with a clinical high risk (1281/17,071) received a GEP. GEP use was associated with significantly increased odds of CT administration in clinical low-risk patients (OR = 2.12 95% CI: 1.44-3.11). In clinical high-risk patients, GEP use was associated with a decreased frequency of CT administration (OR = 0.55, 95% CI: 0.48-0.63). Adherence to the GEP result was higher in clinical high-risk patients with a discordant GEP result as compared to clinical low-risk patients with a discordant GEP result: 71.7% vs. 52.2%, respectively. CONCLUSION GEP is frequently used outside the indicated area and significantly influenced the administration of adjuvant CT, although adherence to the test result was limited.
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Affiliation(s)
- K Schreuder
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - A Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E J Th Rutgers
- Department of Surgery, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C H Smorenburg
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Th van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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Diessner J, Wischnewsky M, Blettner M, Häusler S, Janni W, Kreienberg R, Stein R, Stüber T, Schwentner L, Bartmann C, Wöckel A. Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study. PLoS One 2016; 11:e0168730. [PMID: 27992550 PMCID: PMC5167411 DOI: 10.1371/journal.pone.0168730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/05/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision. METHODS In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading. RESULTS There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46-1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45-1.88). CONCLUSIONS The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings-that are in line with several publications-should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.
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Affiliation(s)
- Joachim Diessner
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen Bremen, Germany
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), University of Mainz, Mainz, Germany
| | - Sebastian Häusler
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Wolfgang Janni
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Rolf Kreienberg
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Roland Stein
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Tanja Stüber
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Lukas Schwentner
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Catharina Bartmann
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Achim Wöckel
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
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Gaß P, Fasching PA, Fehm T, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Brucker SY, Beckmann MW, Wallwiener D, Kümmel S, Löhberg CR. Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study. Breast Care (Basel) 2016; 11:315-322. [PMID: 27920623 DOI: 10.1159/000452468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. METHODS Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. RESULTS In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. CONCLUSION There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.
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Affiliation(s)
- Paul Gaß
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Germany; Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | | | - Mahdi Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf, Germany
| | - Bernd Baier
- Frauenklinik im Klinikum Dachau, Dachau, Germany
| | - Gerold Baake
- Onkologische Praxis Pinneberg, Pinneberg, Germany
| | | | | | - Mathias Warm
- Brustzentrum, Universitäts-Frauenklinik Köln, Cologne, Germany; Brustzentrum, Klinken der Stadt Köln, Holweide, Cologne, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, und CCC, Munich, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, und CCC, Munich, Germany
| | | | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | | | | | - Cosima Brucker
- Universitätsklinik für Frauenheilkunde, Paracelsus Medizinische Privatuniversität, Nuremberg, Germany
| | - Jan W Siebers
- Frauenklinik der St. Josefsklinik, Offenburg, Germany
| | - Nikos Fersis
- Frauenklinik, Klinikum Bayreuth, Bayreuth, Germany
| | | | | | | | | | - Wolfgang Janni
- Frauenklinik des Universitätsklinikums Ulm, Ulm, Germany
| | - Robert Landthaler
- Gynäkologische Praxis in der Kreisklinik Krumbach, Krumbach, Germany
| | - Andreas Kohls
- Evangelisches Krankenhaus Ludwigsfelde-Teltow, Teltow, Germany
| | | | - Thomas Noesselt
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Hameln-Pyrmont, Hameln, Germany
| | | | | | | | - Volker Heyl
- Schwerpunkt-Medizin für minimal invasive Chirurgie, Senologie und Onkologie Mainz, Mainz, Germany
| | - Thorsten Kühn
- Frauenklinik, Städtische Kliniken, Esslingen a.N., Germany
| | | | - Christoph Thomssen
- Frauenklinik, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andre Hohn
- Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Hans Tesch
- Onkologie Bethanien, Frankfurt/M., Germany
| | - Christoph Mundhenke
- Frauenklinik, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Adib Jacob
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | | | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt/M., Germany
| | - Sara Y Brucker
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Frauenklinik, St. Theresien-Krankenhaus, Nuremberg, Germany
| | - Diethelm Wallwiener
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Sherko Kümmel
- Brustzentrum, Kliniken Essen Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Christian R Löhberg
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Frauenklinik, St. Theresien-Krankenhaus, Nuremberg, Germany
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Verschoor AMF, Kuijer A, Verloop J, Van Gils CH, Sonke GS, Jager A, van Dalen T, Elias SG. Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level. Breast Cancer Res Treat 2016; 159:357-65. [PMID: 27514397 DOI: 10.1007/s10549-016-3940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022]
Abstract
Over recent years, adjuvant systemic treatment guidelines (AST) for early-stage breast cancer have changed considerably. We aimed to assess the impact of these guideline changes on the administration of AST in early-stage breast cancer patients and to what extent these guidelines are adhered to at a nation-wide level. We used Netherlands Cancer Registry data to describe trends in AST prescription, adherence to AST guidelines, and to identify clinicopathological determinants of nonadherence. Between 1990 and 2012, 231,648 Dutch patients were diagnosed with early breast cancer, of whom 124,472 received AST. Adjuvant endocrine treatment (ET) use increased from 23 % of patients (1990) to 56 % (2012), and chemotherapy from 11 to 44 %. In 2009-2012, 8 % of patients received ET and 3 % received chemotherapy without guideline indication. Conversely, 10-29 % of patients did not receive ET and chemotherapy, respectively, despite a guideline indication. Unfavorable clinicopathological characteristics generally decreased the chance of undertreatment and increased the chance for overtreatment. Remarkable was the increased chance of ET undertreatment in younger women (RR < 35 vs 60-69 years 1.79; 95 % CI 1.30-2.47) and in women with HER2+ disease (RR 1.64; 95 % CI 1.46-1.85). Over the years, AST guidelines expanded resulting in much more Dutch early breast cancer patients receiving AST. In the majority of cases, AST administration was guideline concordant, but the high frequency of chemotherapy undertreatment in some subgroups suggests limited AST guideline support in these patients.
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Affiliation(s)
- A M F Verschoor
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - A Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - J Verloop
- Department of Research, Netherlands Comprehensive Cancer Organization, Postbus 19079, 3501 DB, Utrecht, The Netherlands
| | - C H Van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A Jager
- Department of Medical Oncology, Erasmus Medical Cancer Institute, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - T van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - S G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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