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Hatzipanagiotou ME, Pigerl M, Gerken M, Räpple S, Zeltner V, Hetterich M, Ugocsai P, Inwald EC, Klinkhammer-Schalke M, Ortmann O, Seitz S. Clinical impact of delaying initiation of adjuvant chemotherapy in patients with early triple negative breast cancer. Breast Cancer Res Treat 2024; 204:607-615. [PMID: 38238552 PMCID: PMC10959785 DOI: 10.1007/s10549-023-07207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE The optimal time to initiation of adjuvant chemotherapy (TTAC) for triple negative breast cancer (TNBC) patients is unclear. This study evaluates the association between TTAC and survival in TNBC patients. METHODS We conducted a retrospective study using data from a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018, registered in the Tumor Centre Regensburg was conducted. Data included demographics, pathology, treatment, recurrence and survival. TTAC was defined as days from primary surgery to first dose of adjuvant chemotherapy. The Kaplan-Meier method was used to evaluate impact of TTAC on overall survival (OS) and 5-year OS. RESULTS A total of 245 TNBC patients treated with adjuvant chemotherapy and valid TTAC data were included. Median TTAC was 29 days. The group receiving systemic therapy within 22 to 28 days after surgery had the most favorable outcome, with median OS of 10.2 years. Groups receiving systemic therapy between 29-35 days, 36-42 days, and more than 6 weeks after surgery had significantly decreased median survival, with median OS of 8.3 years, 7.8 years, and 6.9 years, respectively. Patients receiving therapy between 22-28 days had significantly better survival compared to those receiving therapy between 29-35 days (p = 0.043), and patients receiving therapy after 22-28 days also demonstrated significantly better survival compared to those receiving therapy after more than 43 days (p = 0.033). CONCLUSION Timing of adjuvant systemic therapy can influence OS in TNBC patients. Efforts should be made to avoid unnecessary delays in administering chemotherapy to ensure timely initiation of systemic therapy and optimize patient outcomes.
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Affiliation(s)
- Maria Eleni Hatzipanagiotou
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany.
| | - Miriam Pigerl
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Sophie Räpple
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Verena Zeltner
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Madeleine Hetterich
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Peter Ugocsai
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Elisabeth Christine Inwald
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg - Centre for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
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Elder E, Fasola C, Clavin N, Hecksher A, Trufan S, Schepel C, Donahue E, Warren Y, White RL, Hadzikadic-Gusic L. Anatomic Location of Tissue Expander Placement Is Not Associated With Delay in Adjuvant Therapy in Women With Breast Cancer. Ann Plast Surg 2023; 91:679-685. [PMID: 37856209 DOI: 10.1097/sap.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Tissue expanders in breast reconstruction are traditionally placed retropectoral. Increasingly, patients are undergoing prepectoral placement. The impact of this placement on the initiation of adjuvant treatment is unknown. METHODS A retrospective review was conducted to identify women diagnosed with breast cancer who underwent mastectomy followed by radiation and/or chemotherapy. Women were divided into 3 groups: prepectoral tissue expander placement, retropectoral tissue expander placement, and no immediate reconstruction. A treatment delay was defined as greater than 8 weeks between tissue expander placement and adjuvant therapy. RESULTS Of 634 women, 205 (32%) underwent tissue expander placement, and 429 (68%) did not have immediate reconstruction. Of those with tissue expanders placed, 84 (41%) had prepectoral placement, and 121 (59%) had retropectoral placement. The median time to adjuvant therapy was 49 days for the entire cohort: no reconstruction, 47 days; prepectoral, 57 days; and retropectoral, 55 days. Treatment delays were observed in 34% of women: no reconstruction, 28%; prepectoral, 51%; and retropectoral, 46% ( P < 0.001). Tissue expander placement was associated with a delay to adjuvant therapy when compared with no reconstruction ( P < 0.001). The location of the tissue expander did not impact the odds of having a delay. On multivariable analysis, having reconstruction, having postoperative infection, not undergoing chemotherapy treatment, and being a current smoker were associated with a delay to adjuvant therapy. A delay to treatment was not associated with worse survival. CONCLUSIONS Placement of a tissue expander delayed adjuvant therapy. The location of tissue expander placement, retropectoral versus prepectoral, did not impact the time to adjuvant treatment.
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Affiliation(s)
- Erin Elder
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Carolina Fasola
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Nicholas Clavin
- Division of Plastic Surgery, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute
| | | | - Sally Trufan
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC
| | | | - Erin Donahue
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC
| | - Yancey Warren
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Richard L White
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Lejla Hadzikadic-Gusic
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
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Morante Z, Ferreyra Y, Pinto JA, Valdivieso N, Castañeda C, Vidaurre T, Valencia G, Rioja P, Fuentes H, Cotrina JM, Neciosup S, Gomez HL. Subpopulation treatment effect pattern plot analysis: a prognostic model for distant recurrence-free survival to estimate delayed adjuvant chemotherapy initiation effect in triple-negative breast cancer. Front Oncol 2023; 13:1193927. [PMID: 38023174 PMCID: PMC10657890 DOI: 10.3389/fonc.2023.1193927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Triple-negative breast cancer (TNBC) is a heterogeneous disease associated with a poor prognosis. Delaying in time to start adjuvant chemotherapy (TTC) has been related to an increased risk of distant recurrence-free survival (DRFS). We aimed to develop a prognostic model to estimate the effects of delayed TTC among TNBC risk subgroups. Materials and methods We analyzed 687 TNBC patients who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). Database was randomly divided to create a discovery set (n=344) and a validation set (n=343). Univariate and multivariate Cox regression models were performed to identify prognostic factors for DRFS. Risk stratification was implemented through two models developed based on proportional hazard ratios from significant clinicopathological characteristics. Subpopulation treatment effect pattern plot (STEPP) analysis was performed to determine the best prognostic cut-off points for stratifying TNBC subgroups according to risk scores and estimate Kaplan-Meier differences in 10-year DRFS comparing TTC (≤30 vs.>30 days). Results In univariate analysis, patients aged ≥70 years (HR=4.65; 95% CI: 2.32-9.34; p=<0.001), those at stages pT3-T4 (HR=3.28; 95% CI: 1.57-6.83; p=0.002), and pN2-N3 (HR=3.00; 95% CI: 1.90-4.76; p=<0.001) were notably associated with higher risk. STEPP analysis defined three risk subgroups for each model. Model N°01 categorized patients into low (score: 0-31), intermediate (score:32-64), and high-risk (score: 65-100) cohorts; meanwhile, Model N°02: low (score: 0-26), intermediate (score: 27-55), and high (score: 56-100). Kaplan-Meier plots showed that in the discovery set, patients with TTC>30 days experienced a 17.5% decrease in 10-year DRFS rate (95%CI=6.7-28.3), and the impact was more remarkable in patients who belong to the high-risk subgroup (53.3% decrease in 10 years-DRFS rate). Similar results were found in the validation set. Conclusions We developed two prognostic models based on age, pT, and pN to select the best one to classify TNBC. For Model N°02, delayed adjuvant chemotherapy conferred a higher risk of relapse in patients ≥70 years and who were characterized by pT3/T4 and pN2/N3. Thus, more efforts should be considered to avoid delayed TTC in TNBC patients, especially those in high-risk subgroups.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Oncosalud, AUNA, Lima, Peru
| | - Yomali Ferreyra
- Departamento de Bioingeniería, Universidad de Ingeniería y Tecnología, Lima, Peru
| | - Joseph A. Pinto
- Centro de Investigación Básica y traslacional, Auna Ideas, Lima, Peru
| | - Natalia Valdivieso
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Castañeda
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Tatiana Vidaurre
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Guillermo Valencia
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Patricia Rioja
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - José M. Cotrina
- Departamento de Cirugía en Mamas y Tejidos Blandos, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L. Gomez
- Oncosalud, AUNA, Lima, Peru
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Peru
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Strobl MAR, Gallaher J, Robertson-Tessi M, West J, Anderson ARA. Treatment of evolving cancers will require dynamic decision support. Ann Oncol 2023; 34:867-884. [PMID: 37777307 PMCID: PMC10688269 DOI: 10.1016/j.annonc.2023.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 10/02/2023] Open
Abstract
Cancer research has traditionally focused on developing new agents, but an underexplored question is that of the dose and frequency of existing drugs. Based on the modus operandi established in the early days of chemotherapies, most drugs are administered according to predetermined schedules that seek to deliver the maximum tolerated dose and are only adjusted for toxicity. However, we believe that the complex, evolving nature of cancer requires a more dynamic and personalized approach. Chronicling the milestones of the field, we show that the impact of schedule choice crucially depends on processes driving treatment response and failure. As such, cancer heterogeneity and evolution dictate that a one-size-fits-all solution is unlikely-instead, each patient should be mapped to the strategy that best matches their current disease characteristics and treatment objectives (i.e. their 'tumorscape'). To achieve this level of personalization, we need mathematical modeling. In this perspective, we propose a five-step 'Adaptive Dosing Adjusted for Personalized Tumorscapes (ADAPT)' paradigm to integrate data and understanding across scales and derive dynamic and personalized schedules. We conclude with promising examples of model-guided schedule personalization and a call to action to address key outstanding challenges surrounding data collection, model development, and integration.
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Affiliation(s)
- M A R Strobl
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa; Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - J Gallaher
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - M Robertson-Tessi
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - J West
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - A R A Anderson
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa.
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Yildiz S, Bildik G, Benlioglu C, Turan V, Dilege E, Ozel M, Kim S, Oktem O. Breast cancer treatment and ovarian function. Reprod Biomed Online 2023; 46:313-331. [PMID: 36400663 DOI: 10.1016/j.rbmo.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study was to provide an update on ovarian function and the mechanisms of gonadal damage after exposure to chemotherapy in breast cancer survivors. The alkylating agents are toxic to both primordial and growing follicles. However, anti-metabolite drugs are more likely to destroy preantral and antral follicles. Younger patients are more likely to have a higher ovarian reserve, and therefore, more likely to retain some residual ovarian function after exposure to gonadotoxic regimens. However, there can be significant variability in ovarian reserve among patients of the same age. Furthermore, patients with critically diminished ovarian reserve may continue to menstruate regularly. Therefore age and menstrual status are not reliable indicators of good ovarian reserve and might give a false sense of security and result in an adverse outcome if the patient is consulted without considering more reliable quantitative markers of ovarian reserve (antral follicle count and anti-Müllerian hormone) and fertility preservation is not pursued. In contrast to well-documented ovarian toxicity of older chemotherapy regimens, data for newer taxane-containing protocols have only accumulated in the last decade and data are still very limited regarding the impact of targeted therapies on ovarian function.
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Affiliation(s)
- Sule Yildiz
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Gamze Bildik
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston TX 77054, USA
| | - Can Benlioglu
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Volkan Turan
- Istanbul Tema Hospital, Assisted Reproduction Unit, Istanbul
| | - Ece Dilege
- Department of General Surgery, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Melis Ozel
- Department of Gynecology and Obstetrics Klinikum Ingolstadt, Bavaria, Germany
| | - Samuel Kim
- Eden Centers for Advanced Fertility, Fullerton CA 92835, USA
| | - Ozgur Oktem
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey.
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6
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Gao W, Wang J, Yin S, Geng C, Xu B. An appropriate treatment interval does not affect the prognosis of patients with breast Cancer. HOLISTIC INTEGRATIVE ONCOLOGY 2022; 1:8. [PMID: 37520334 PMCID: PMC9255457 DOI: 10.1007/s44178-022-00010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/09/2022] [Indexed: 12/24/2022]
Abstract
Purpose Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment. How much do these delays and treatment changes affect treatment outcomes in patients with breast cancer? Methods This review summarized relevant research in the past three decades and identified the effect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment, neoadjuvant treatment, surgery, postoperative chemotherapy, radiotherapy, and targeted therapies. Results Delay in seeking medical help for ≥12 weeks affected the prognosis. Surgical treatment within 4 weeks of diagnosis did not affect patient prognosis. Starting neoadjuvant chemotherapy within 8 weeks after diagnosis, receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy, and receiving radiotherapy 8 weeks after surgery did not affect patient prognosis. Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer. Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B, triple-negative, or HER2-positive breast cancer treated with trastuzumab will adversely affect the prognosis. Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60 days after surgery or 4 months after diagnosis. Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy. Conclusion Different treatments have different time sensitivities, and the careful evaluation and management of these delays will be helpful in minimizing the negative effects on patients.
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Affiliation(s)
- Wei Gao
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Jiaxing Wang
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Sifei Yin
- Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305 USA
| | - Cuizhi Geng
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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Ozcan MCH, Snegovskikh V, Adamson GD. Oocyte and embryo cryopreservation before gonadotoxic treatments: Principles of safe ovarian stimulation, a systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221074886. [PMID: 35130799 PMCID: PMC8829712 DOI: 10.1177/17455065221074886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Review the safety of fertility preservation through ovarian stimulation with oocyte or embryo cryopreservation, including cycle and medication options. EVIDENCE REVIEW A systematic review of peer-reviewed sources revealed 2 applicable randomized control trials and 60 cohort studies as well as 20 additional expert opinions or reviews. RESULTS The capacity for future family building is important for the majority of reproductive age people, despite life-altering medical or oncologic diagnosis. Modern fertility preservation generates a high rate of oocyte yield while utilizing protocols that can be started at multiple points in the menstrual cycle and suppressing supra-physiologic levels of estrogen. Finally, more than one quarter of fertility preservation patients will return to later utilize fertility services. CONCLUSION For most patients, fertility preservation can safely be pursued and completed within 2 weeks without affecting disease severity or long-term survival.
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Affiliation(s)
- Meghan CH Ozcan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
- Meghan CH Ozcan, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 90 Plain St., Providence, RI 02903, USA.
| | - Victoria Snegovskikh
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
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Meyer C, Bailleux C, Chamorey E, Schiappa R, Delpech Y, Dejode M, Fouché Y, Haudebourg J, Barranger E. Factors Involved in Delaying Initiation of Adjuvant Chemotherapy After Breast Cancer Surgery. Clin Breast Cancer 2021; 22:121-126. [PMID: 34154927 DOI: 10.1016/j.clbc.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Delays in initiating adjuvant chemotherapy after breast cancer surgery seems to have an impact on patients' risk of relapse and their survival rate. The aim of this retrospective study was to identify factors delaying initiation of adjuvant chemotherapy after breast surgery. MATERIAL AND METHODS All patients undergoing surgical treatment for mammary cancer between June 2014 and June 2015 and receiving adjuvant chemotherapy were selected retrospectively. RESULTS In multivariate analysis, 3 factors significantly delay initiation of adjuvant chemotherapy: a secondary procedure (odds ratio [OR], 6.67; P = .00012), inclusion in a therapeutic trial (OR, 8.46; P = .0013), and a positive HER2 status (OR, 3.02; P = .063 [statistically significant]). DISCUSSION This study provides a brief overview of the population most likely to experience a delay in the initiation of their adjuvant chemotherapy after cancer surgery. Our findings should assist interventions during initial management.
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Affiliation(s)
- C Meyer
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique.
| | | | - E Chamorey
- Département d'Epidémiologie, de Biostatistiques et des Données de Santé
| | - R Schiappa
- Département d'Epidémiologie, de Biostatistiques et des Données de Santé
| | - Y Delpech
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - M Dejode
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - Y Fouché
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - J Haudebourg
- Laboratoire d'Anatomopathologie, Centre Antoine Lacassagne, Nice, France
| | - E Barranger
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
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Buonomoa B, Peccatorib FA. Fertility preservation in endocrine responsive breast cancer: data and prejudices. Ecancermedicalscience 2021; 14:1157. [PMID: 33574902 PMCID: PMC7864682 DOI: 10.3332/ecancer.2020.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 12/21/2022] Open
Abstract
Even if current guidelines suggest an early referral of young breast cancer (BC) patients to fertility preservation counselling, physicians still lack knowledge about the different available strategies. Hormonal stimulation to harvest mature oocytes is considered unsafe by many oncologists and experts in reproductive medicine, particularly in the setting of oestrogen receptor-positive BC. The aim of this mini-review is to provide an overview on the available data about this topic in order to clarify potential misunderstandings and to highlight the new trends in the oncofertility field with their pros and limitations.
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10
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Cullinane C, Shrestha A, Al Maksoud A, Rothwell J, Evoy D, Geraghty J, McCartan D, McDermott EW, Prichard RS. Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:1507-1513. [PMID: 33589241 DOI: 10.1016/j.ejso.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Administration of chemotherapy before breast surgery has the potential to reduce the risk of distant recurrence by targeting micrometastasis as well as allowing a more minimalistic approach to surgical intervention. We performed a systematic review to determine the optimum timing of surgery post breast cancer neoadjuvant chemotherapy (NACT). METHODS The primary outcome was to determine whether the timing of surgery post NACT impacted overall survival (OS) and disease-free survival (DFS). We compared patient outcomes between those who had surgery within 8 weeks of completion of NACT to those that had surgery after 8 weeks. An outcome comparison between <4 weeks and 4-8 weeks was also performed. Secondary outcome included complete pathological response (pCR) post NACT. A meta-analysis was performed using the Mantel-Haenszel method. RESULTS Five studies, including 8794 patients were eligible for inclusion. Patients that had surgery within 8 weeks of completion of NACT had a statistically significant improved OS(OR 0.47, 95% c. i 0.34-0.65) and DFS(OR 0.71 (95% c. i 0.52-0.98, P = 0.04). There were no survival advantages associated with having surgery less than 4 weeks post completion of NACT (OR 0.78, 95% c. i 0.46-1.33, P = 0.37). There was no difference in pCR rate between those that had surgery <4 weeks and 4-8 weeks (OR 1.01, 95% c. i 0.80-1.28, P = 0.93). CONCLUSION This meta-analysis shows that the optimum timing of surgery post completion of NACT is 4-8 weeks as it is associated with increased OS and DFS.
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Affiliation(s)
- Carolyn Cullinane
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Amber Shrestha
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Ahmed Al Maksoud
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Jane Rothwell
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Denis Evoy
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - James Geraghty
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Damian McCartan
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Enda W McDermott
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Ruth S Prichard
- Department of General, Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland.
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Ashok Kumar P, Paulraj S, Wang D, Huang D, Sivapiragasam A. Associated factors and outcomes of delaying adjuvant chemotherapy in breast cancer by biologic subtypes: a National Cancer Database study. J Cancer Res Clin Oncol 2021; 147:2447-2458. [PMID: 33517468 PMCID: PMC7847714 DOI: 10.1007/s00432-021-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
Purpose Several studies have evaluated the role of delayed initiation of adjuvant chemotherapy (AC) in breast cancer (BC), but the results have remained controversial and an optimal time has not been defined. Our aim was to determine the effect of time to starting AC from the date of surgery on survival of BC patients, based on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, using data from the National Cancer Database (NCDB). Methods A total of 332,927 Stage I–III BC patients who received AC from 2010 to 2016 were analyzed. We included all ER, PR and HER2 statuses and excluded patients with stage 4 and stage 0 (DCIS) disease. The cohort was divided into five groups based on the time of initiating AC from the date of the most definitive surgery i.e., ≤ 30 days, 31–60 days, 61–90 days, 91–120 days and > 120 days. They were further divided into five subgroups based on the receptor status. Results Hazard ratio (HR) estimates and Kaplan–Meier (KM) analysis shows that starting AC by 31–60 days shows the best survival outcome in all the subtypes, except in hormone positive/HER2 negative BC in which 31–60 days and 61–90 days have similar outcomes. Conclusions After surgery for BC, it takes around 4–6 weeks to begin AC and delay in initiating the same leads to poor outcomes. Our results are particularly significant in triple-negative breast cancer (TNBC), similar to prior studies showing a benefit to starting AC as early as possible after surgery.
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Affiliation(s)
- Prashanth Ashok Kumar
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA. .,Department of Internal Medicine, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
| | - Shweta Paulraj
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Danning Huang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Abirami Sivapiragasam
- Department of Hematology-Oncology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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12
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Al-Masri M, Aljalabneh B, Al-Najjar H, Al-Shamaileh T. Effect of time to breast cancer surgery after neoadjuvant chemotherapy on survival outcomes. Breast Cancer Res Treat 2021; 186:7-13. [PMID: 33475879 DOI: 10.1007/s10549-020-06090-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) and disease-free survival (DFS) in breast cancer patients who received NACT followed by surgery. METHODS This is a retrospective analysis of 468 patients with breast cancer (stage I-III) who received and completed the same regimen of NACT (Anthracyclines and Taxanes B27 protocol) at King Hussein Cancer Center (KHCC) (2006-2014). Patients have been divided into three groups according to the duration between the end of NACT and surgery, <4 weeks, 4-8 weeks and >8 weeks. RESULTS Most patients were stages II-III breast cancer with only four patients with stage I. Almost all patients (99%) had either invasive ductal or invasive lobular carcinomas. Adjuvant radiotherapy was given to 96% of patients. Most patients were alive at the time of analysis (84%). Complete pathological response was achieved in 20% of patients. Local recurrence rate was 6.6% with a median follow up of 3.8 years (interquartile range 0.6-10.9). Analysis showed that the groups had equivalent DFS. However, OS was adversely affected if patients had their surgery after 8 weeks of NACT compared to those who had their surgery between 4 and 8 weeks. CONCLUSIONS Breast cancer surgery post NACT within the first 8 weeks had no impact on survival. However, surgery after 8 weeks of NACT showed negative impact on OS. Therefore, delaying surgery after 8 weeks is not recommended.
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Affiliation(s)
- Mahmoud Al-Masri
- Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan.
| | - Basim Aljalabneh
- Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan
| | - Hani Al-Najjar
- Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan
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13
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Hammond JB, Han GR, Cronin PA, Kosiorek HE, Rebecca AM, Casey WJ, Kruger EA, Teven CM, Pockaj BA. Exploring the Effect of Post-mastectomy complications on 5-year survival. Am J Surg 2020; 220:1422-1427. [PMID: 32921402 DOI: 10.1016/j.amjsurg.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ramifications of postoperative complications on long-term survival after mastectomy are uncertain. METHODS Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS). RESULTS A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P < 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction. CONCLUSIONS Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.
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Affiliation(s)
| | - Ga-Ram Han
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heide E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Erwin A Kruger
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Chad M Teven
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA.
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14
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Moloney BM, McAnena PF, Ryan ÉJ, Beirn EO, Waldron RM, Connell AO, Walsh S, Ennis R, Glynn C, Lowery AJ, McCarthy PA, Kerin MJ. The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420948477. [PMID: 32863709 PMCID: PMC7430084 DOI: 10.1177/1178223420948477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 01/28/2023]
Abstract
Objective Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. Methods Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR-). Results There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; χ2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. Conclusion While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.
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Affiliation(s)
- Brian M Moloney
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Peter F McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Ellen O Beirn
- Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Ronan M Waldron
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - AnnaMarie O Connell
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Sinead Walsh
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Rachel Ennis
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Catherine Glynn
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Peter A McCarthy
- Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland
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15
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16
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Hampe ME, Rhoton-Vlasak AS. Fertility preservation in breast cancer with case-based examples for guidance. J Assist Reprod Genet 2020; 37:717-729. [PMID: 32008180 PMCID: PMC7125269 DOI: 10.1007/s10815-019-01665-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
With more young breast cancer survivors, a trend toward having children later in life, and improvements in assisted reproductive technology (ART), fertility preserving techniques are of growing importance prior to initiation of gonadotoxic treatments. The American Society for Clinical Oncology (ASCO) updated their Fertility Preservation in Patients with Cancer guidelines in April of 2018. ASCO continues to recognize oocyte and embryo cryopreservation as standard practice for women interested in preserving fertility and sperm cryopreservation as standard practice for men. ASCO has clarified their statement on ovarian suppression during chemotherapy as an option when standard methods are unavailable but should not be used as the sole method of fertility preservation (FP) due to conflicting evidence. ASCO also updated their statement on ovarian tissue cryopreservation, which is still labeled experimental but ASCO acknowledges that it can restore global ovarian function and could be of use in specific patients. The NCCN's Version 1.2018 Clinical Practice Guidelines® for treatment of breast cancer include fertility counseling as part of their work-up in all types of breast cancer for premenopausal women.The purpose of this review is to explain the indications and evidence for the different methods of FP for young breast cancer patients in accordance with ASCO and NCCN guidelines. The guidance will then be applied to three theoretical clinical cases in order to highlight actual use in clinical practice.
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Affiliation(s)
- Mary E Hampe
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alice S Rhoton-Vlasak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA.
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17
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Oncoplastic Breast Surgery Compared to Conventional Breast-Conserving Surgery With Regard to Oncologic Outcome. Clin Breast Cancer 2019; 19:423-432.e5. [DOI: 10.1016/j.clbc.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/26/2022]
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18
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Heeg E, Harmeling JX, Becherer BE, Marang-van de Mheen PJ, Vrancken Peeters MTFD, Mureau MAM. Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy. Br J Surg 2019; 106:1640-1648. [PMID: 31386193 PMCID: PMC6852599 DOI: 10.1002/bjs.11300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 01/05/2023]
Abstract
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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Affiliation(s)
- E Heeg
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J X Harmeling
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - B E Becherer
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - P J Marang-van de Mheen
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - M T F D Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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19
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Kupstas AR, Hoskin TL, Day CN, Habermann EB, Boughey JC. Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Cancer Database Analysis. Ann Surg Oncol 2019; 26:3240-3249. [PMID: 31332635 DOI: 10.1245/s10434-019-07566-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Timeliness of care is emerging as a quality indicator for breast cancer care. We sought to evaluate the impact of surgical treatment type on time to adjuvant chemotherapy and impact of treatment delay on survival. METHODS Patients with stage I-III breast cancer treated with both surgery and adjuvant chemotherapy from 2010 to 2014 were identified from the National Cancer Database (NCDB). Delay in treatment was defined as > 120 days from diagnosis to chemotherapy. Multivariable analysis was performed to assess factors associated with delay in treatment and the effect of treatment delay on overall survival. RESULTS Of 172,043 patients identified, 89.5% initiated chemotherapy within 120 days of diagnosis. Median time from diagnosis to surgery was shorter in patients undergoing breast conservation (25 days) than mastectomy (29 days, p < 0.001) and within mastectomy patients was shorter for mastectomy without reconstruction (26 versus 35 days, p < 0.001). Time from diagnosis to surgery showed larger differences between surgical groups than time from surgery to chemotherapy. On multivariable analysis of mastectomy patients, reconstruction remained significantly associated with delay to chemotherapy [odds ratio (OR) 1.7, p < 0.001]. For all patients regardless of type of surgery, after adjusting for patient, clinical, and treatment factors, delay of > 120 days from diagnosis to chemotherapy was associated with worse overall survival [hazard ratio (HR) 1.29, p < 0.001]. CONCLUSIONS Initiation of chemotherapy greater than 120 days after diagnosis was associated with poorer overall survival. Time interval from diagnosis to surgery had the greatest impact on time from diagnosis to chemotherapy, with reconstruction resulting in the greatest delay.
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Affiliation(s)
| | - Tanya L Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Courtney N Day
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Elizabeth B Habermann
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
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20
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Pomponio MK, Keele LJ, Fox KR, Clark AS, Matro JM, Shulman LN, Tchou JC. Does time to adjuvant chemotherapy (TTC) affect outcomes in patients with triple-negative breast cancer? Breast Cancer Res Treat 2019; 177:137-143. [PMID: 31119565 DOI: 10.1007/s10549-019-05282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE A recent study reported that time to adjuvant chemotherapy (TTC) > 30 days was significantly associated with worse OS and DFS in triple-negative breast cancer (TNBC). Earlier studies, however, found that worse outcomes were associated with TTC > 60 days or > 90 days. As the trend for mastectomy with reconstruction continues to rise, TTC of < 30 days is often not feasible due to wound-healing issues in some of these patients. To elucidate the impact of TTC, we sought to evaluate the clinical outcomes associated with TTC in a contemporary cohort treated for TNBC at a single institution. METHODS A single-institution database was queried to identify nonmetastatic TNBC patients who received adjuvant chemotherapy from 2009 to 2018. TTC was defined as interval between date of surgery and adjuvant chemotherapy start date. Median TTC was used to divide our cohort into four quartiles; ≤ 31, 32-42, 43-56, and > 56 days. Logrank, Kaplan-Meier, and inverse probability weighting (IPW) tests were used to analyze disease-free (DFS) and overall survival (OS). RESULTS The mean TTC of our study cohort (n = 724) was 48 days (median TTC = 42 days). Black race, mastectomy without adjuvant radiation, and mastectomy with immediate reconstruction were associated with delayed TTC (all p-values < 0.01). In multivariate IPW analysis, TTC > 56 (n = 173) days did not impact DFS or OS compared to TTC ≤ 31 (n = 198) days (p = 0.27 and p = 0.21, respectively). Similar results were seen during subgroup analysis for groups identified as higher risk for delayed TTC. CONCLUSION Our results demonstrated that TTC was not significant or significantly associated with DFS or OS in patient receiving chemotherapy for operable TNBC. Our results were reassuring for patients electing mastectomy with immediate reconstruction, who may experience a longer TTC.
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Affiliation(s)
- Maria K Pomponio
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Luke J Keele
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin R Fox
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy S Clark
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer M Matro
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia C Tchou
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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21
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Kitano A, Shimizu C, Yamauchi H, Akitani F, Shiota K, Miyoshi Y, Ohde S. Factors associated with treatment delay in women with primary breast cancer who were referred to reproductive specialists. ESMO Open 2019; 4:e000459. [PMID: 30962960 PMCID: PMC6435250 DOI: 10.1136/esmoopen-2018-000459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/03/2019] [Accepted: 01/19/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose Cancer treatment delay due to fertility preservation procedures is a barrier for patients with breast cancer who wish to preserve their fertility. This study aimed to describe the associations between fertility preservation and treatment delay in patients with breast cancer with reproductive concerns and assess the factors related to treatment delay. Methods Patients with primary breast cancer who visited the reproductive unit at our institution before cancer treatment between 2007 and 2015 were enrolled. The treatment delay cut-off was defined as follows: time to chemotherapy (TTC) >8 weeks for patients intending to receive neoadjuvant chemotherapy, TTC >12 weeks for patients intending to receive adjuvant chemotherapy, time to endocrine therapy (TTE) >12 weeks for patients intending to receive endocrine therapy without radiation therapy and TTE >20 weeks for patients intending to receive endocrine therapy after radiation therapy. Multivariable models were constructed to examine the factors of treatment delay. Results Overall, 212 patients met the inclusion criteria. Using the defined cut-offs, treatment delay was noted in 18% of the patients. Endocrine therapy was related to treatment delay (OR 4.49, 95% CI 1.02 to 19.7; p=0.05), but fertility preservation by artificial reproductive treatment (ART) was not. Pregnancy and delivery following treatment for breast cancer were achieved in 18 (19%) and 15 (16%) patients who underwent fertility preservation with ART. Conclusion Fertility preservation with ART was not associated with treatment delay in patients with breast cancer who were referred to reproductive specialists before cancer treatment.
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Affiliation(s)
- Atsuko Kitano
- Department of Medical Oncology, St Luke's International Hospital, Tokyo, Japan.,Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chikako Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine Research Institute, Shinjuku-ku, Japan
| | - Hideko Yamauchi
- Department of Breast Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Fumi Akitani
- Department of Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
| | | | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Tokyo, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
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22
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Risk Factors for Delays in Adjuvant Chemotherapy following Immediate Breast Reconstruction. Plast Reconstr Surg 2019; 142:299-305. [PMID: 29782396 DOI: 10.1097/prs.0000000000004547] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns exist that immediate breast reconstruction may delay adjuvant chemotherapy initiation, impacting oncologic outcomes. Here, the authors determine how postoperative complications impact chemotherapy timing, and identify factors associated with greater risk for delays. METHODS Retrospective chart review identified patients undergoing immediate breast reconstruction and adjuvant chemotherapy at a single institution from 2010 to 2015. Patients were analyzed based on occurrence of postoperative complications and time to chemotherapy. RESULTS A total of 182 patients (244 breast reconstructions) were included in the study; 210 (86 percent) reconstructions did not experience postoperative complications, and 34 (13.9 percent) did. Patients who experienced postoperative complications had an older mean age (53.6 years versus 48.1 years; p = 0.002) and higher rates of diabetes (23.5 percent versus 3.8 percent; p < 0.001). The complication group had delays in initiation of chemotherapy (56 versus 45 days; p = 0.017). Patients who initiated chemotherapy more than 48.5 days after reconstruction were of older mean age (55.9 years versus 50.7 years; p = 0.074) and had increased rates of diabetes (36.8 percent versus 6.7 percent; p = 0.053) and immediate autologous reconstruction (31.6 percent versus 0 percent; p = 0.027). A predictive model determined that patients with at least one of these three risk factors have a 74 percent chance of experiencing prolonged times to chemotherapy initiation. CONCLUSIONS Risk factors for delayed chemotherapy in the context of postoperative complications are age older than 51.7 years, diabetes, and autologous reconstruction. Reconstructive candidates who fit this profile are at highest risk and merit extra consideration. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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23
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Cazzaniga ME, Ciruelos E, Fabi A, Garcia-Saenz J, Lindman H, Mavroudis D, Schem C, Steger G, Timotheadou E, Zaman K, Torri V. Metastatic or locally advanced breast cancer patients: towards an expert consensus on nab-paclitaxel treatment in HER2-negative tumours-the MACBETH project. Cancer Chemother Pharmacol 2018; 83:301-318. [PMID: 30460489 DOI: 10.1007/s00280-018-3717-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the large use of nab-paclitaxel as a treatment option in metastatic breast cancer (MBC) across different countries, no definitive data are available in particular clinical situations. AREAS COVERED Efficacy, safety and schedule issues concerning available literature on nab-paclitaxel in advanced breast cancer and in specific subgroups of patients have been discussed and voted during an International Expert Meeting. Ten expert specialists in oncology, with extensive clinical experience on Nab-P and publications in the field of MBC have been identified. Six scientific areas of interest have been covered, generating 13 specific Statements for Nab-P, after literature review. For efficacy issues, a summary of research quality was performed adopting the GRADE algorithm for evidence scoring. The panel members were invited to express their opinion on the statements, in case of disagreement all the controversial opinions and the relative motivations have been made public. EXPERT OPINION Consensus was reached in 30.8% of the Nab-P statements, mainly those regarding safety issues, whereas ones regarding efficacy and schedule still remain controversial areas, requiring further data originated by the literature.
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Affiliation(s)
- Marina E Cazzaniga
- Phase 1 Trials Research Unit and Oncology Unit, ASST Monza and Milano Bicocca School of Medicine, Via GB Pergolesi 33, 20900, Monza, MB, Italy. .,Oncology Unit, ASST Monza, Monza, Italy.
| | - E Ciruelos
- Unidad de Cáncer de Mama del Centro Integral Oncológico Clara Campal HM CIOCC, Madrid, Spain
| | - A Fabi
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - J Garcia-Saenz
- Department of Medical Oncology, IdISSC. CIBERONC-ISCIII, Hospital Clínico San Carlos, Madrid, Spain
| | - H Lindman
- Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden
| | - D Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - C Schem
- Mammazentrum, Hamburg, Germany
| | - G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - E Timotheadou
- Aristotle University of Thessaloniki School of Medicine, Papageorgiou Gen. Hospital, Thessaloníki, Greece
| | - K Zaman
- Breast Center, Department of Oncology, University Hospital CHUV, Lausanne, Switzerland
| | - V Torri
- Istituto IRCCS Istituto Mario Negri, Milan, Italy
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Bleicher RJ, Chang C, Wang CE, Goldstein LJ, Kaufmann CS, Moran MS, Pollitt KA, Suss NR, Winchester DP, Tafra L, Yao K. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 2018; 173:603-617. [DOI: 10.1007/s10549-018-5046-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Even small delays in the treatment of breast cancer are a frequently expressed concern of patients. Knowledge about this subject is important for clinicians to counsel patients appropriately and realistically, while also optimizing care. Although data and quality measures regarding time to chemotherapy and radiotherapy have been present for some time, data regarding surgical care are more recent and no standard exists. This review was written to discuss our current knowledge about the relationship of treatment times to outcomes. METHODS The published medical literature addressing delays and optimal times to treatment was reviewed in the context of our current time-dependent standards for chemotherapy and radiotherapy. The surgical literature and the lack of a time-dependent surgical standard also were discussed, suggesting a possible standard. RESULTS Risk factors for delay are numerous, and tumor doubling times are both difficult to determine and unhelpful to assess the impact of longer treatment times on outcomes. Evaluation components also have a time cost and are inextricable from the patient's workup. Although the published literature has lack of uniformity, optimal times to each modality are strongly suggested by emerging data, supporting the current quality measures. Times to surgery, chemotherapy, and radiotherapy all have a measurable impact on outcomes, including disease-free survival, disease-specific survival, and overall survival. CONCLUSIONS Delays have less of an impact than often thought but have a measurable impact on outcomes. Optimal times from diagnosis are < 90 days for surgery, < 120 days for chemotherapy, and, where chemotherapy is administered, < 365 days for radiotherapy.
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Affiliation(s)
- Richard J Bleicher
- Department of Surgical Oncology, Room C-308, Fox Chase Cancer Center, Philadelphia, PA, USA.
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26
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Outcomes of early-stage breast cancer patients treated with sequential anthracyclines–taxanes in relationship to relative dosing intensity: a secondary analysis of a randomized controlled trial. Clin Transl Oncol 2018; 21:239-245. [DOI: 10.1007/s12094-018-1915-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/25/2018] [Indexed: 01/08/2023]
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Larson KE, Grobmyer SR, Karafa M, Pratt D. Time to treatment and survival in triple negative breast cancer patients receiving trimodality treatment in the United States. Cancer Treat Res Commun 2018; 16:32-37. [PMID: 31299000 DOI: 10.1016/j.ctarc.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Time from diagnosis to treatment for breast cancer patients has been linked to outcomes. Our goal was to assess the relationship between survival, time to first treatment (TFT), and time to treatment completion (TTC) in Stage I-III triple negative breast cancer (TNBC) receiving trimodality therapy (surgery, chemotherapy, and radiation). METHODS National Cancer Database (NCDB) was queried for TNBC patients diagnosed with Stage I-III disease from 2010 to 2011 who received all treatments (surgery, chemotherapy, radiation) within 18 months of diagnosis. Multivariate analysis controlled for age, stage, operation, neoadjuvant chemotherapy (NAC), and comorbidities. RESULTS 17,717 women were included. Most had early stage disease (34.1% Stage 1; 48.2% Stage 2) treated with lumpectomy (69.2%) and adjuvant chemotherapy (63.3%). During follow-up (2.8 ± 1.1 years), mortality was 11.4%. TFT was 34.8 days for NAC and 35.6 days for surgery. Multivariate analysis demonstrated no mortality difference when considering TFT in 30 day (p = 0.43) or 6 week (p = 0.91) intervals. When separating into NAC or surgery first, there remained no mortality difference when considering TFT in 30 day (NAC p = 0.96, surgery p = 0.26) or 6 week (NAC p = 0.91, surgery p = 0.91) intervals. Overall, TTC was 9.0 ± 1.8 months. When dividing patients into tertiles by TTC, multivariate analysis demonstrated no survival difference between groups (p = 0.9). There was also no mortality difference for each 30 day increased TTC (p = 0.40). CONCLUSIONS In Stage I-III TNBC patients receiving trimodality therapy, TFT (NAC or surgery) and TTC do not impact short-term survival if TTC is <18 months.
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Affiliation(s)
- K E Larson
- Department of General Surgery, Division of Breast Services, Cleveland Clinic, Cleveland, OH, USA; Department of Surgery, Division of Breast Surgery, University of Kansas Health System, Kansas City, KS, USA
| | - S R Grobmyer
- Department of General Surgery, Division of Breast Services, Cleveland Clinic, Cleveland, OH, USA
| | - M Karafa
- Department of Quantitate Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - D Pratt
- Department of General Surgery, Division of Breast Services, Cleveland Clinic, Cleveland, OH, USA.
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Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials. Breast 2018; 38:175-180. [DOI: 10.1016/j.breast.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/17/2023] Open
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Zhan QH, Fu JQ, Fu FM, Zhang J, Wang C. Survival and time to initiation of adjuvant chemotherapy among breast cancer patients: a systematic review and meta-analysis. Oncotarget 2017; 9:2739-2751. [PMID: 29416807 PMCID: PMC5788675 DOI: 10.18632/oncotarget.23086] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/17/2017] [Indexed: 12/21/2022] Open
Abstract
The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. In order to illustrate the effect of delaying the initiation of AC on survival we have undertaken a systematic review and meta-analysis. We identified 12 available studies in the meta-analysis including 15 independent analytical groups. This meta-analysis showed that a 4-week delay before AC was associated with a significantly worse overall survival (OS)(HR=1.13; 95% confidence interval [CI], 1.08–1.19) and disease free survival (DFS)(HR=1.14; 95%CI, 1.05–1.24). Two studies categorized patients into hormone receptor-positive, ERBB2-positive, and triple-negative breast cancer (TNBC) patients according to the clinicopathological features of breast cancer. The HRs for OS between waiting time (WT) ≤30 days and 31–60 days in the subgroups were extracted and analyzed. The analysis demonstrated that a WT of 31–60 days was related to worse OS among patients with TNBC (HR, 1.26; 95% CI, 1.08–1.48), but had no significant effect on OS among those with hormone receptor-positive (HR, 1.02; 95% CI, 0.89–1.15) or ERBB2-postive (HR, 0.95; 95%CI, 0.79–1.14) tumors. In this meta-analysis of the eligible literatures reviewing the time to AC, a longer waiting time to adjuvant chemotherapy may lead to worse survival in breast cancer patients, especially in TNBC patients.
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Affiliation(s)
- Qiao-Hui Zhan
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Jian-Qin Fu
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Fang-Meng Fu
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Jie Zhang
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Chuan Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
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Taylan E, Oktay KH. Current state and controversies in fertility preservation in women with breast cancer. World J Clin Oncol 2017; 8:241-248. [PMID: 28638793 PMCID: PMC5465013 DOI: 10.5306/wjco.v8.i3.241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
On average, over 25000 women are diagnosed with breast cancer under the age of 45 annually in the United States. Because an increasing number of young women delay childbearing to later life for various reasons, a growing population of women experience breast cancer before completing childbearing. In this context, preservation of fertility potential of breast cancer survivors has become an essential concept in modern cancer care. In this review, we will outline the currently available fertility preservation options for women with breast cancer of reproductive age, discuss the controversy behind hormonal suppression for gonadal protection against chemotherapy and highlight the importance of timely referral by cancer care providers.
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31
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Chien AJ, Chambers J, Mcauley F, Kaplan T, Letourneau J, Hwang J, Kim MO, Melisko ME, Rugo HS, Esserman LJ, Rosen MP. Fertility preservation with ovarian stimulation and time to treatment in women with stage II-III breast cancer receiving neoadjuvant therapy. Breast Cancer Res Treat 2017; 165:151-159. [PMID: 28503722 DOI: 10.1007/s10549-017-4288-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether fertility preservation with ovarian stimulation (OS) results in treatment delay in breast cancer (BC) patients receiving neoadjuvant therapy (NAT). METHODS This is a retrospective study of women screened for the prospective neoadjuvant ISPY2 trial at the University of California San Francisco. All patients were <43, had stage II-III BC, and received neoadjuvant therapy. Time to initiation of NAT was compared between women who underwent OS (STIM) and women who did not (control). Patient and tumor characteristics, as well as oncologic outcomes, were compared between STIM and control groups. RESULTS 82 patients were included (34 STIM and 48 control). STIM patients were overall younger (mean = 35 vs. 36.9 years old, p = 0.06), and more likely to be childless (79.4 vs 31.2%, p < 0.0001) than controls. Mean time from diagnosis to initiation of NAT was 40 days, with no significant difference between STIM and control groups (mean 39.8 days vs 40.9 days, p = 0.75). Mean time from diagnosis to fertility consultation was 16.3 days. With median follow-up of 79 months, 16 (19.5%) patients have recurred or died from BC. Rates of pCR, recurrence, and death were similar in both groups. Six of 34 STIM patients have undergone embryo transfer, resulting in one patient with two live births. CONCLUSION Fertility preservation with OS can be performed in the neoadjuvant setting without delay in initiation of systemic therapy and should be discussed with all early-stage BC patients of reproductive age.
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Affiliation(s)
- A Jo Chien
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA.
| | - Julia Chambers
- University of California San Francisco School of Medicine, Francisco, CA, USA
| | - Fiona Mcauley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Tessa Kaplan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jimmy Hwang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mi-Ok Kim
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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32
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Walsh EM, O'Kane GM, Cadoo KA, Graham DM, Korpanty GJ, Power DG, Carney DN. Is chemotherapy always required for cancer in pregnancy? An observational study. Ir J Med Sci 2017; 186:875-881. [PMID: 28477329 DOI: 10.1007/s11845-017-1602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer in pregnancy is relatively rare, but the incidence is increasing. Several studies show that cytotoxic agents are safe to use in pregnancy from the second trimester onwards. AIMS This study assesses the maternal and foetal outcomes of cancers diagnosed during pregnancy. In particular, it focuses on a subset of women who elected to defer systemic chemotherapy until after delivery. This study examines if all cancers need to be treated during pregnancy or if, in certain cases, treatment can be safely deferred until after full-term delivery. METHODS This is a retrospective observational study of women diagnosed with cancer during pregnancy in an Irish cancer centre over a 27-year period. All women diagnosed with cancer during pregnancy who were referred to the medical oncology department for consideration of chemotherapy were included in this study. Medical and pharmacy records were extensively reviewed. RESULTS Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology for consideration of systemic chemotherapy. Sixteen women (64%) commenced chemotherapy during pregnancy, seven women (28%) did not receive chemotherapy while pregnant, but commenced treatment immediately after delivery, and two (8%) did not receive any systemic chemotherapy at all. Of the seven women who commenced chemotherapy after delivery, six (85.7%) were diagnosed before 30/40 gestation. There were three cases of Hodgkin's lymphoma, two breast cancers and one ovarian cancer. After a median follow-up of 12 years, all six mothers remain disease-free. CONCLUSIONS This study identified a select cohort of patients that did not receive chemotherapy during pregnancy. There were no adverse outcomes to mothers due to delayed treatment.
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Affiliation(s)
- E M Walsh
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - G M O'Kane
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - K A Cadoo
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY, USA
| | - D M Graham
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - G J Korpanty
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital and Mercy University Hospital, Cork, Ireland
| | - D N Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
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Klit A, Tvedskov TF, Kroman N, Elberg JJ, Ejlertsen B, Henriksen TF. Oncoplastic breast surgery does not delay the onset of adjuvant chemotherapy: a population-based study. Acta Oncol 2017; 56:719-723. [PMID: 28162018 DOI: 10.1080/0284186x.2017.1281437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only a few studies of limited size have examined whether oncoplastic breast surgery delays the onset of adjuvant chemotherapy as compared to conventional breast surgery. We investigated whether oncoplastic breast surgery causes a delay in the onset of adjuvant chemotherapy in comparison to lumpectomy and mastectomy. MATERIAL AND METHODS The study is a population-based cohort study. Within the nationwide registry of the Danish Breast Cancer Group (DBCG), we identified 1798 patients who received adjuvant chemotherapy following mastectomy, lumpectomy or oncoplastic breast surgery for early and unilateral invasive breast cancer. Women treated with neoadjuvant chemotherapy were excluded. RESULTS We found no significant difference between the three groups (mastectomy, lumpectomy, oncoplastic breast surgery) in the time from biopsy to surgery (mean time 17.9, 17.0 and 18.3 days, respectively), the time from surgery to onset of adjuvant chemotherapy, nor total time from biopsy to the onset of adjuvant chemotherapy (mean time 52.7, 51.9 and 53.2 days, respectively). CONCLUSIONS Our study shows that oncoplastic breast surgery does not delay the onset of adjuvant chemotherapy in comparison with mastectomy and lumpectomy. Accordingly, patients should not be excluded from treatment with oncoplastic breast surgery due to concerns of delay in adjuvant chemotherapy.
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Affiliation(s)
- Anders Klit
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tove Filtenborg Tvedskov
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Breast Cancer Group, The Danish Cancer Society, Copenhagen, Denmark
| | - Jens Jørgen Elberg
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, The Danish Cancer Society, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Foged Henriksen
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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He X, Ye F, Zhao B, Tang H, Wang J, Xiao X, Xie X. Risk factors for delay of adjuvant chemotherapy in non-metastatic breast cancer patients: A systematic review and meta-analysis involving 186982 patients. PLoS One 2017; 12:e0173862. [PMID: 28301555 PMCID: PMC5354309 DOI: 10.1371/journal.pone.0173862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/28/2017] [Indexed: 01/11/2023] Open
Abstract
Purpose Delay performance of adjuvant chemotherapy (AC) after surgery has been presented to affect survival of breast cancer patients adversely, but the risk factors for delay in initiation remain controversial. Therefore, we conducted this systematic review of the literature and meta-analysis aiming at identifying the risk factors for delay of adjuvant chemotherapy (DAC) in non-metastatic breast cancer patients. Methods The search was performed on PubMed, Embase, Chinese National Knowledge Infrastructure and Wanfang Database from inception up to July 2016. DAC was defined as receiving AC beyond 8-week after surgery. Data were combined and analyzed using random-effects model or fixed-effects model for risk factors considered by at least 3 studies. Heterogeneity was analyzed with meta-regression analysis of year of publication and sample size. Publication bias was studied with Egger’s test. Results A total of 12 observational studies including 186982 non-metastatic breast cancer patients were eligible and 12 risk factors were analyzed. Combined results demonstrated that black race (vs white; OR, 1.18; 95% CI, 1.01–1.39), rural residents (vs urban; OR, 1.60; 95% CI, 1.27–2.03) and receiving mastectomy (vs breast conserving surgery; OR, 1.35; 95% CI, 1.00–1.83) were significantly associated with DAC, while married patients (vs single; OR, 0.58; 95% CI, 0.38–0.89) was less likely to have a delay in initiation. No significant impact from year of publication or sample size on the heterogeneity across studies was found, and no potential publication bias existed among the included studies. Conclusions Risk factors associated with DAC included black race, rural residents, receiving mastectomy and single status. Identifying of these risk factors could further help decisions making in clinical practice.
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Affiliation(s)
- Xiaofang He
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fen Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Bingcheng Zhao
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jin Wang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiangsheng Xiao
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- * E-mail:
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Mansfield SA, Abdel-Rasoul M, Terando AM, Agnese DM. Timing of Breast Cancer Surgery-How Much Does It Matter? Breast J 2017; 23:444-451. [PMID: 28117507 DOI: 10.1111/tbj.12758] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Timing of surgical resection after breast cancer diagnosis is dependent on a variety of factors. Lengthy delays may lead to progression; however, the impact of modest delays is less clear. The aim of this study was to evaluate the impact of surgical timing on outcomes, including disease-free survival (DFS) and nodal status (NS). The cancer registry from one academic cancer hospital was retrospectively reviewed. Time from initial biopsy to surgical resection was calculated for patients with ductal carcinoma in situ (DCIS) and stage 1 and 2 invasive carcinomas. Early (0-21 days), intermediate (22-42 days), and late (43-63 days) surgery groups were evaluated for differences in NS and DFS for each cancer stage separately. A total of 3,932 patients were identified for analysis. There were no differences in DFS noted for DCIS. For stage 1, early surgery (ES) was associated with worse DFS compared to intermediate surgery (IS) (p = 0.025). There were no significant differences between ES and late surgery (LS) (p = 0.700) or IS and LS (p = 0.065). In stage II cancers, there was a significant difference in DFS in ES compared to IS (p < 0.001) and LS (p = 0.009). There was no significant difference between IS and LS (p = 0.478). Patients were more likely to undergo immediate reconstruction (p < 0.0001 for all stages) in later time-to-surgery groups, while patients in earlier groups were more likely to undergo breast conserving surgery. There was also no significant difference in NS at time of surgery in clinical stage 1 (p = 0.321) or stage 2 disease (p = 0.571). Delays of up to 60 days were not associated with worse outcomes. This study should reassure patients and surgeons that modest delays do not adversely affect breast cancer outcomes. This allows patients time to consider treatment and reconstruction options.
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Affiliation(s)
- Sara A Mansfield
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alicia M Terando
- Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Doreen M Agnese
- Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
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Alexander M, Blum R, Burbury K, Coutsouvelis J, Dooley M, Fazil O, Griffiths T, Ismail H, Joshi S, Love N, Opat S, Parente P, Porter N, Ross E, Siderov J, Thomas P, White S, Kirsa S, Rischin D. Timely initiation of chemotherapy: a systematic literature review of six priority cancers - results and recommendations for clinical practice. Intern Med J 2017; 47:16-34. [DOI: 10.1111/imj.13190] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Alexander
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - R. Blum
- Department of Medical Oncology; Bendigo Health; Bendigo Victoria Australia
| | - K. Burbury
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - J. Coutsouvelis
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - M. Dooley
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - O. Fazil
- Pharmacy Department; Monash Health; Melbourne Victoria Australia
| | - T. Griffiths
- Olivia Newton-John Cancer Wellness and Research Centre; Austin Health; Melbourne Victoria Australia
| | - H. Ismail
- Departments of Pharmacy; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. Joshi
- Department of Medical Oncology; Latrobe Regional Hospital; Traralgon Victoria Australia
| | - N. Love
- Department of Nursing; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - S. Opat
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - P. Parente
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
- Department of Eastern Clinical School; Monash University; Melbourne Victoria Australia
| | - N. Porter
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - E. Ross
- Division of Neurosciences, Cancer and Infection Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Siderov
- Pharmacy Department; Austin Health; Melbourne Victoria Australia
| | - P. Thomas
- Departments of Nursing; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. White
- Department of Medical Oncology; Northern Hospital; Melbourne Victoria Australia
| | - S. Kirsa
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - D. Rischin
- Department of Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Omarini C, Guaitoli G, Noventa S, Andreotti A, Gambini A, Palma E, Papi S, Tazzioli G, Balduzzi S, Dominici M, Cascinu S, Piacentini F. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol 2016; 43:613-618. [PMID: 27793416 DOI: 10.1016/j.ejso.2016.09.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The optimal time interval between the end of neoadjuvant systemic therapy (NST) and breast surgery is still unclear. It is not known if a delay in surgery might influence the benefit of primary chemotherapy. The aim of this study is to evaluate the relationship between time to surgery (TTS) and survival outcomes. PATIENTS AND METHODS According to TTS, women with diagnosis of BC treated with NST were divided into two cohorts: group A = 21 days or fewer and group B = longer than 21 days. OS and RFS were estimated and compared according to TTS and known prognostic factors. RESULTS A total of 319 patients were included in the study: 61 in group A and 258 in group B. Median TTS was 34 days. No association between clinical stage, nuclear grade, type of chemotherapy, type of surgery and TTS was detected. OS and RFS were significantly worse for group B compared with group A, with a hazard ratio of 3.1 (95% CI, 1.1-8.6 p = 0.03) and 3.1 (95% CI, 1.3-7.1 p = 0.008) respectively. Multivariate analysis confirmed that TTS was an independent prognostic factor in term of OS (p = 0.03) and RFS (p = 0.01). Even in the subgroup of patients with pCR, TTS continued to be an independent prognostic factor for both OS and RFS (p = 0.05 and p = 0.03). CONCLUSIONS TTS after NST seems to influence survival outcomes. BC patients underwent surgery within 21 days experienced maximal benefit from previous treatment: this advantage is consistent and maintained over time.
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Affiliation(s)
- C Omarini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
| | - G Guaitoli
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Noventa
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - A Andreotti
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - A Gambini
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - E Palma
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Papi
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - G Tazzioli
- Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Balduzzi
- Department of Medicine and Public Health, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - M Dominici
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - S Cascinu
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy
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Raphael MJ, Biagi JJ, Kong W, Mates M, Booth CM, Mackillop WJ. The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2016; 160:17-28. [DOI: 10.1007/s10549-016-3960-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/24/2016] [Indexed: 01/11/2023]
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Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer. JAMA Oncol 2016; 2:322-9. [PMID: 26659132 DOI: 10.1001/jamaoncol.2015.3856] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Adjuvant chemotherapy improves outcomes of patients with breast cancer. However, the optimal timing of chemotherapy initiation is unknown. Delayed administration can decrease the benefit of cytotoxic systemic therapies. OBJECTIVE To identify the determinants in delayed chemotherapy initiation and to determine the relationship between time to chemotherapy (TTC) and outcome according to breast cancer subtype. We hypothesized that prolonged TTC would be associated with adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS In an observational, population-based investigation using data from the California Cancer Registry, we studied a total of 24 843 patients with stage I to III invasive breast cancer diagnosed between January 1, 2005, and December 31, 2010, and treated with adjuvant chemotherapy. Data analysis was performed between August 2014 and August 2015. MAIN OUTCOMES AND MEASURES Time to chemotherapy was defined as the number of days between surgery and the first dose of chemotherapy, and delayed TTC was defined as 91 or more days from surgery to the first dose of adjuvant chemotherapy. We evaluated overall survival and breast cancer-specific survival. Logistic regression and Cox proportional hazard models were used. RESULTS In all, 24 843 patients were included. Median age at diagnosis was 53 years, and median was TTC was 46 days. Factors associated with delays in TTC included low socioeconomic status, breast reconstruction, nonprivate insurance, and Hispanic ethnicity or non-Hispanic black race. Compared with patients receiving chemotherapy within 31 days from surgery, there was no evidence of adverse outcomes among those with TTC of 31 to 60 or 60 to 90 days. Patients treated 91 or more days from surgery experienced worse overall survival (hazard ratio [HR], 1.34; 95% CI, 1.15-1.57) and worse breast cancer-specific survival (HR, 1.27; 95% CI, 1.05-1.53). In a subgroup analysis according to subtype, longer TTC caused patients with triple-negative breast cancer to have worse overall survival (HR, 1.53; 95% CI, 1.17-2.00) and worse breast cancer-specific survival (HR, 1.53; 95% CI 1.17-2.07). CONCLUSIONS AND RELEVANCE For patients with breast cancer, adverse outcomes are associated with delaying initiation of adjuvant chemotherapy 91 or more days. Delayed TTC was particularly detrimental among patients with triple-negative breast cancer. The determinants of delays in chemotherapy initiation appeared to be sociodemographic, and clinicians should provide timelier care to all patients.
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Affiliation(s)
- Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston2Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston2Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston
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Srikanthan A, Amir E, Warner E. Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral? Breast 2016; 27:22-6. [DOI: 10.1016/j.breast.2016.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/21/2016] [Accepted: 02/28/2016] [Indexed: 11/25/2022] Open
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Gallagher CM, More K, Kamath T, Masaquel A, Guerin A, Ionescu-Ittu R, Gauthier-Loiselle M, Nitulescu R, Sicignano N, Butts E, Wu EQ, Barnett B. Delay in initiation of adjuvant trastuzumab therapy leads to decreased overall survival and relapse-free survival in patients with HER2-positive non-metastatic breast cancer. Breast Cancer Res Treat 2016; 157:145-56. [PMID: 27107569 PMCID: PMC4869764 DOI: 10.1007/s10549-016-3790-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/05/2016] [Indexed: 01/03/2023]
Abstract
Trastuzumab reduces the risk of relapse in women with HER2-positive non-metastatic breast cancer, but little information exists on the timing of trastuzumab initiation. The study investigated the impact of delaying the initiation of adjuvant trastuzumab therapy for >6 months after the breast cancer diagnosis on time to relapse, overall survival (OS), and relapse-free survival (RFS) among patients with non-metastatic breast cancer. Adult women with non-metastatic breast cancer who initiated trastuzumab adjuvant therapy without receiving any neoadjuvant therapy were selected from the US Department of Defense health claims database from 01/2003 to 12/2012. Two study cohorts were defined based on the time from breast cancer diagnosis to trastuzumab initiation: >6 months and ≤6 months. The impact of delaying trastuzumab initiation on time to relapse, OS, and RFS was estimated using Cox regression models adjusted for potential confounders. Of 2749 women in the study sample, 79.9 % initiated adjuvant trastuzumab within ≤6 months of diagnosis and 20.1 % initiated adjuvant trastuzumab >6 months after diagnosis. After adjusting for confounders, patients who initiated trastuzumab >6 months after the breast cancer diagnosis had a higher risk of relapse, death, or relapse/death than those who initiated trastuzumab within ≤6 months of diagnosis (hazard ratios [95 % CIs]: 1.51 [1.22-1.87], 1.54 [1.12-2.12], and 1.43 [1.16-1.75]; respectively). The results of this population-based study suggest that delays of >6 months in the initiation of trastuzumab among HER2-positive non-metastatic breast cancer patients are associated with a higher risk of relapse and shorter OS and RFS.
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Affiliation(s)
- Christopher M Gallagher
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street, NW, Room C-2149, Washington, DC, 20010-2975, USA.
| | - Kenneth More
- Virginia Oncology Associates, Virginia Beach, VA, USA
| | | | | | | | | | | | | | - Nicholas Sicignano
- Health ResearchTx LLC, Trevose, VA, USA
- Navy and Marine Corps Public Health Center, Portsmouth, VA, USA
| | - Elizabeth Butts
- Navy and Marine Corps Public Health Center, Portsmouth, VA, USA
| | - Eric Q Wu
- Analysis Group, Inc., Boston, MA, USA
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Trufelli DC, Matos LLD, Santi PX, Del Giglio A. Adjuvant treatment delay in breast cancer patients. Rev Assoc Med Bras (1992) 2016; 61:411-6. [PMID: 26603003 DOI: 10.1590/1806-9282.61.05.411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/05/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS). METHOD data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed. RESULTS three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test). CONCLUSION each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.
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Sanford RA, Lei X, Barcenas CH, Mittendorf EA, Caudle AS, Valero V, Tripathy D, Giordano SH, Chavez-MacGregor M. Impact of Time from Completion of Neoadjuvant Chemotherapy to Surgery on Survival Outcomes in Breast Cancer Patients. Ann Surg Oncol 2015; 23:1515-21. [PMID: 26678405 DOI: 10.1245/s10434-015-5020-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND No studies have examined the impact of the interval from conclusion of neoadjuvant chemotherapy to surgery in breast cancer patients. This study was undertaken to investigate the relationship between time interval from neoadjuvant chemotherapy to surgery and survival outcomes. METHODS Breast cancer patients diagnosed with stage I-III disease who received neoadjuvant chemotherapy June 1995 to April 2007 were identified. The effect of neoadjuvant chemotherapy to surgery interval, defined as ≤4, 4-6, or >6 weeks, on survival outcomes was examined. Descriptive statistics and Cox proportional hazards models were used. RESULTS A total of 1101 patients were identified. Median time to surgery was 33 (range 8-159) days; 335 patients (30.4 %) had surgery within 4 weeks of their last dose of neoadjuvant chemotherapy, 524 (47.6 %) within 4-6 weeks, and 242 (22.0 %) after more than 6 weeks. Median follow-up was 94 (range 3-178) months. The 5-year overall survival (OS) estimates were 79, 87, and 81 % in patients who underwent surgery ≤4, 4-6, and >6 weeks after neoadjuvant chemotherapy, respectively (p = 0.03). The three groups did not differ in 5-year recurrence-free survival (RFS) or locoregional recurrence-free survival (LRFS). In multivariable analysis, compared with an interval of ≤4 weeks, patients who underwent surgery at 4-6 or >6 weeks had equivalent OS, LRFS, and RFS; a sensitivity analysis suggested worse OS in patients who underwent surgery at >8 weeks. CONCLUSIONS Patients with neoadjuvant chemotherapy to surgery intervals of up to 8 weeks had equivalent OS, RFS, and LRFS.
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Affiliation(s)
- Rachel A Sanford
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Williams F. Assessment of Breast Cancer Treatment Delay Impact on Prognosis and Survival: a Look at the Evidence from Systematic Analysis of the Literature. JOURNAL OF CANCER BIOLOGY & RESEARCH 2015; 3:1071. [PMID: 34258389 PMCID: PMC8274552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Breast cancer has remained the most commonly diagnosed disease among women globally. Despite the advancement in biomedical sciences leading to improve survival outcomes, some patients endure longer wait periods prior to initiation of treatment. OBJECTIVE To elucidate the impact of treatment delay on breast cancer patient's quality of life and survivorship. Second was to determine the optimal length of time (delay) between breast cancer diagnosis and start of first treatment in order to improve prognosis and general health and well-being of survivors. METHODS Systematic search of the literature was conducted across five electronic databases: Pub Med, EMBASE, CINAHL, Scopus and Science Direct as well as the reference list of all articles retrieved. RESULTS A total of 33 articles were included in the evidence based systematic review, which comprised of 255,366 observations. The results of the studies were categorized under five main themes as: study characteristics, cancer staging and classification, treatment delay time definition and interval, treatment regimen classification and delay impact on quality of life and survival. Analyzed wait times from diagnosis to the initiation of first therapy ranged from 7 days to a period of over 180 days. Combinations of standardized treatment including loco-regional radiotherapy, systemic chemotherapy surgery as well as hormonal therapy were examined. Even though some of the studies showed mixed results, overall, findings indicated that early detection, diagnosis and initiation of treatment within 90 days increase survival. CONCLUSIONS Evidence revealed that delaying the initiation of treatment for breast cancer more than 90 days after diagnosis has a detrimental effect on disease free and overall well-being of survivors.
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Affiliation(s)
- Faustine Williams
- Corresponding author: Faustine Williams, Department of Surgery, Washington University, Social System Design Lab, George Warren Brown School of Social Work, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO 63110, USA, Tel: 1-573-289-6165;
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Xavier Harmeling J, Kouwenberg CAE, Bijlard E, Burger KNJ, Jager A, Mureau MAM. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review. Breast Cancer Res Treat 2015; 153:241-51. [PMID: 26285643 PMCID: PMC4559567 DOI: 10.1007/s10549-015-3539-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/10/2015] [Indexed: 10/29/2022]
Abstract
Adjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The current systematic review aims to investigate this effect. During October 2014, a systematic search for clinical studies was performed in six databases with keywords related to breast reconstruction and chemotherapy. Eligible studies met the following inclusion criteria: (1) research population consisted of women receiving therapeutic mastectomy, (2) comparison of IBR with mastectomy only groups, (3) TTC was clearly presented and mentioned as outcome measure, and (4) original studies only (e.g., cohort study, randomized controlled trial, case-control). Fourteen studies were included, representing 5270 patients who had received adjuvant chemotherapy, of whom 1942 had undergone IBR and 3328 mastectomy only. One study found a significantly shorter mean TTC of 12.6 days after IBR, four studies found a significant delay after IBR averaging 6.6-16.8 days, seven studies found no significant difference in TTC between IBR and mastectomy only, and two studies did not perform statistical analyses for comparison. In studies that measured TTC from surgery, mean TTC varied from 29 to 61 days for IBR and from 21 to 60 days for mastectomy only. This systematic review of the current literature showed that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent, suggesting that in general IBR is a valid option for non-metastatic breast cancer patients.
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Affiliation(s)
- J Xavier Harmeling
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Farolfi A, Scarpi E, Rocca A, Mangia A, Biglia N, Gianni L, Tienghi A, Valerio MR, Gasparini G, Amaducci L, Faedi M, Baldini E, Rubagotti A, Maltoni R, Paradiso A, Amadori D. Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer. Eur J Cancer 2015. [PMID: 26206258 DOI: 10.1016/j.ejca.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the optimal time interval from definitive surgery to commencing chemotherapy in early breast cancer (EBC). PATIENTS AND METHODS The relationship between time to initiation of adjuvant chemotherapy (TTC), calculated in weeks, and disease-free (DFS) or overall survival (OS), was assessed in 921 EBC patients with rapidly proliferating tumours (thymidine labelling index >3% or G3 or Ki67 >20%), randomised in a phase III clinical trial (NCT01031030) to receive chemotherapy with or without anthracyclines (epirubicin→cyclophosphamide, methotrexate and fluorouracil (CMF) versus CMF→epirubicin versus CMF). DFS, OS and 95% confidence intervals (95% confidence interval (CI)) were calculated by the Kaplan-Meier method. Multivariate Cox analysis was performed in relation with nodal involvement, oestrogen receptor and human epidermal growth factor receptor 2 (HER2) status, Ki67 value, type of adjuvant chemotherapy, menopausal status and tumour size. RESULTS At a median follow-up of 105 months (range 2-188), a prolonged TTC resulted in a significant increase in the risk of relapse: hazard ratio (HR) 1.15 (95% CI 1.02-1.30, p=0.019). Using a backward elimination procedure, TTC, tumour size and nodal involvement remained significantly associated with DFS. A time-dependent receiver-operating characteristic (ROC) curve analysis was subsequently utilised to evaluate the best cut-off for TTC, identifying 7 weeks as the best threshold for longer OS (p=0.043): 8-year OS 88% (95% CI 85-90) for patients with a TTC <7 weeks and 78% (95% CI 68-87) for the other group. CONCLUSIONS Our results confirm that a shorter TTC may reduce relapses and possibly also improve clinical outcome in patients with highly proliferating EBC.
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Affiliation(s)
- Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, Istituto Tumori "Giovanni Paolo II"-IRCCS, Bari, Italy
| | - Nicoletta Biglia
- Obstetrics and Gynaecology Unit, University of Torino Medical School, Torino, Italy
| | - Lorenzo Gianni
- Department of Oncology, Per gli Infermi Hospital, Rimini, Italy
| | - Amelia Tienghi
- Oncology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | | | | | | | - Marina Faedi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Alessandra Rubagotti
- Department of Internal Medicine of the University of Genoa and Academic Unit of Medical Oncology, AOU San Martino-IST, Genoa, Italy
| | - Roberta Maltoni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Angelo Paradiso
- Clinical Experimental Oncology Laboratory, Istituto Tumori "Giovanni Paolo II"-IRCCS, Bari, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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IVF for fertility preservation in breast cancer patients--efficacy and safety issues. J Assist Reprod Genet 2015; 32:1171-8. [PMID: 26126877 DOI: 10.1007/s10815-015-0519-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Potential risks on future fertility have become a dominant issue in consultation and management of newly diagnosed young cancer patients. Several fertility preservation strategies are currently available. Of those, ovarian stimulation followed by IVF and embryo cryopreservation is the most established one and is especially applicable in reproductive aged breast cancer patients. AIM The aim of this study is to provide a comprehensive review on ovarian stimulation and IVF for fertility preservation in newly diagnosed breast cancer patients. METHODS Review of relevant literature is available through PubMed and Google scholar. RESULTS The use of IVF for fertility preservation in breast cancer patients raises dilemmas regarding efficacy and safety of controlled ovarian stimulation. Among these are the suggested role of malignancy and BRCA mutation in reducing ovarian response to stimulation, strategies designated to protect against hyper-estrogenic state associated with stimulation (co-treatment with tamoxifen or letrozole), and possible adjustments to accommodate oncologic-related time constraints. CONCLUSION Ovarian stimulation followed by IVF forms an important fertility preservation strategy for newly diagnosed young breast cancer patients, though live born rates following thawed embryo transfer in these patients are still lacking. Recent advances in controlled ovarian stimulation protocols provide practical options for some of the challenges that breast cancer patients present.
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Biglia N, Torrisi R, D'Alonzo M, Codacci Pisanelli G, Rota S, Peccatori FA. Attitudes on fertility issues in breast cancer patients: an Italian survey. Gynecol Endocrinol 2015; 31:458-64. [PMID: 25982361 DOI: 10.3109/09513590.2014.1003293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fertility issues should be discussed with young women before the start of any anticancer treatment. The study is aimed to investigate the attitude on fertility among Italian oncologists and breast surgeons dealing with BCa, and to report the consensus achieved on specific statements. METHODS One hundred and sixty-two panelists anonymously expressed an opinion through a web-based platform on 19 statements based on the Delphi method. RESULTS Ninety-one percent of oncologists considered important to discuss with patients about fertility issues and 83% believed estrogens could stimulate the growth of hidden cancer cells in ER(+) tumors. Difficulties in accessing fertility preservation procedures were mainly due to patients' reluctance, but also to lack of coordination with the assisted reproduction specialists. No full consensus was reached on the prognostic role of pregnancy after BCa. Fifty-four percent of oncologists declared that pregnancy does not affect oncologic prognosis. Treatment with GnRHa during chemotherapy was considered the only mean for preserving ovarian function. CONCLUSIONS Fertility preservation in BCa patients is a well-accepted practice among Italian oncologists. A poor knowledge of this specific issue emerged from the survey, even if a certain degree of agreement was observed on most fertility-related issues.
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Affiliation(s)
- Nicoletta Biglia
- Department of Gynaecology and Obstetrics, University of Turin , Turin , Italy
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Tamoxifen co-administration during controlled ovarian hyperstimulation for in vitro fertilization in breast cancer patients increases the safety of fertility-preservation treatment strategies. Fertil Steril 2014; 102:488-495.e3. [PMID: 24934489 DOI: 10.1016/j.fertnstert.2014.05.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of tamoxifen co-administration during conventional controlled ovarian hyperstimulation (COH) protocols for a fertility-preservation IVF cycle in breast cancer patients. DESIGN Two groups: retrospective descriptive cohort study and prospective study. SETTING Breast cancer oncology and fertility-preservation centers in a tertiary hospital. PATIENT(S) Two groups of breast cancer patients: premenopausal patients treated with adjuvant tamoxifen; and patients undergoing in vitro fertilization (IVF) for fertility preservation. INTERVENTION(S) Fertility-preservation cycles, tamoxifen co-administration during conventional IVF. MAIN OUTCOME MEASURE(S) Endocrine records, and IVF results. RESULT(S) Estradiol (E2) levels were chronically high (mean 2663 pmol/L, maximum: 10,000 pmol/L) in 38 of 46 breast cancer patients treated with adjuvant tamoxifen. Co-administration of tamoxifen (48 cycles) during conventional IVF or without tamoxifen (26 cycles), using either the long gonadotropin-releasing hormone-agonist or-antagonist protocols, resulted, respectively, in a mean of 12.65 and 10.2 oocytes retrieved, and 8.5 and 6.4 embryos cryopreserved. Average peak E2 levels were 6,924 pmol/L and 5,093 pmol/L, respectively, but long-term recurrence risk (up to 10 years) was not increased. CONCLUSION(S) In breast cancer patients, co-administration of tamoxifen during conventional COH for fertility preservation does not interfere with IVF results. The high serum E2 levels during COH should be considered safe, as it simulates the high prevalence of persistently high serum E2 levels in premenopausal breast cancer patients safely treated with adjuvant tamoxifen.
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Colleoni M, Gelber RD. Time to initiation of adjuvant chemotherapy for early breast cancer and outcome: the earlier, the better? J Clin Oncol 2014; 32:717-9. [PMID: 24516011 DOI: 10.1200/jco.2013.54.3942] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marco Colleoni
- International Breast Cancer Study Group; European Institute of Oncology, Milan, Italy
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