Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors

Marco Colleoni, Marco Bonetti, Alan S. Coates, Monica Castiglione-Gertsch, Richard D. Gelber, Karen Price, Carl Magnus Rudenstam, Jurij Lindtner, John Collins, Beat Thürlimann, Stig Holmberg, Andrea Veronesi, Giovanni Marini, Aron Goldhirsch

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Abstract

Purpose: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. An analysis of the International (Ludwig) Breast Cancer Study Group (IBCSG) Trial V at a median follow-up of 11 years suggested that early initiation of adjuvant chemotherapy might improve outcome for premenopausal, node-positive patients whose tumors did not express any estrogen receptor (ER). Patients and Methods: We investigated the relationship between early initiation of adjuvant chemotherapy, ER status, and prognosis in 1,788 premenopausal, node-positive patients treated on IBCSG trials I, II, and VI. The disease-free survival for 599 patients (84 with ER-absent tumors) who commenced adjuvant chemotherapy within 20 days (early initiation) was compared with the disease-free survival for 1,189 patients (142 with ER-absent tumors) who started chemotherapy 21 to 86 days after surgery (conventional initiation). The median follow-up was 7.7 years. Results: Among patients with ER-absent tumors, the 10-year disease-free survival was 60% for the early initiation group compared with 34% for the conventional initiation group (226 patients; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.33 to 0.72; P = .0003]. This difference remained statistically significant in a Cox multiple regression analysis controlling for study group, number of positive nodes, tumor size, age, vessel invasion, and institution (HR, 0.60; 95% CI, 0.39 to 0.92; P = .019). Conversely, early initiation of chemotherapy did not significantly improve disease-free survival far patients with tumors expressing ER (1,562 patients; multiple regression HR, 0.93; 95% CI, 0.79 to 1.10; P = .40). Conclusion: In premenopausal patients with ER-absent tumors, early initiation of systemic chemotherapy after primary surgery might improve outcome. Further confirmatory studies are required before any widespread modification of current clinical practice. In premenopausal patients with tumors expressing some ER, gains from early initiation are unlikely to be clinically significant. (C) 2000 by American Society of Clinical Oncology.

Original languageEnglish
Pages (from-to)584-590
Number of pages7
JournalJournal of Clinical Oncology
Volume18
Issue number3
Publication statusPublished - Feb 2000

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Adjuvant Chemotherapy
Estrogen Receptors
Breast Neoplasms
Neoplasms
Disease-Free Survival
Confidence Intervals
Drug Therapy
Estrogen Receptor alpha
Ambulatory Surgical Procedures
Regression Analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. / Colleoni, Marco; Bonetti, Marco; Coates, Alan S.; Castiglione-Gertsch, Monica; Gelber, Richard D.; Price, Karen; Rudenstam, Carl Magnus; Lindtner, Jurij; Collins, John; Thürlimann, Beat; Holmberg, Stig; Veronesi, Andrea; Marini, Giovanni; Goldhirsch, Aron.

In: Journal of Clinical Oncology, Vol. 18, No. 3, 02.2000, p. 584-590.

Research output: Contribution to journalArticle

Colleoni, M, Bonetti, M, Coates, AS, Castiglione-Gertsch, M, Gelber, RD, Price, K, Rudenstam, CM, Lindtner, J, Collins, J, Thürlimann, B, Holmberg, S, Veronesi, A, Marini, G & Goldhirsch, A 2000, 'Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors', Journal of Clinical Oncology, vol. 18, no. 3, pp. 584-590.
Colleoni, Marco ; Bonetti, Marco ; Coates, Alan S. ; Castiglione-Gertsch, Monica ; Gelber, Richard D. ; Price, Karen ; Rudenstam, Carl Magnus ; Lindtner, Jurij ; Collins, John ; Thürlimann, Beat ; Holmberg, Stig ; Veronesi, Andrea ; Marini, Giovanni ; Goldhirsch, Aron. / Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. In: Journal of Clinical Oncology. 2000 ; Vol. 18, No. 3. pp. 584-590.
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abstract = "Purpose: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. An analysis of the International (Ludwig) Breast Cancer Study Group (IBCSG) Trial V at a median follow-up of 11 years suggested that early initiation of adjuvant chemotherapy might improve outcome for premenopausal, node-positive patients whose tumors did not express any estrogen receptor (ER). Patients and Methods: We investigated the relationship between early initiation of adjuvant chemotherapy, ER status, and prognosis in 1,788 premenopausal, node-positive patients treated on IBCSG trials I, II, and VI. The disease-free survival for 599 patients (84 with ER-absent tumors) who commenced adjuvant chemotherapy within 20 days (early initiation) was compared with the disease-free survival for 1,189 patients (142 with ER-absent tumors) who started chemotherapy 21 to 86 days after surgery (conventional initiation). The median follow-up was 7.7 years. Results: Among patients with ER-absent tumors, the 10-year disease-free survival was 60{\%} for the early initiation group compared with 34{\%} for the conventional initiation group (226 patients; hazard ratio [HR], 0.49; 95{\%} confidence interval [CI], 0.33 to 0.72; P = .0003]. This difference remained statistically significant in a Cox multiple regression analysis controlling for study group, number of positive nodes, tumor size, age, vessel invasion, and institution (HR, 0.60; 95{\%} CI, 0.39 to 0.92; P = .019). Conversely, early initiation of chemotherapy did not significantly improve disease-free survival far patients with tumors expressing ER (1,562 patients; multiple regression HR, 0.93; 95{\%} CI, 0.79 to 1.10; P = .40). Conclusion: In premenopausal patients with ER-absent tumors, early initiation of systemic chemotherapy after primary surgery might improve outcome. Further confirmatory studies are required before any widespread modification of current clinical practice. In premenopausal patients with tumors expressing some ER, gains from early initiation are unlikely to be clinically significant. (C) 2000 by American Society of Clinical Oncology.",
author = "Marco Colleoni and Marco Bonetti and Coates, {Alan S.} and Monica Castiglione-Gertsch and Gelber, {Richard D.} and Karen Price and Rudenstam, {Carl Magnus} and Jurij Lindtner and John Collins and Beat Th{\"u}rlimann and Stig Holmberg and Andrea Veronesi and Giovanni Marini and Aron Goldhirsch",
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T1 - Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors

AU - Colleoni, Marco

AU - Bonetti, Marco

AU - Coates, Alan S.

AU - Castiglione-Gertsch, Monica

AU - Gelber, Richard D.

AU - Price, Karen

AU - Rudenstam, Carl Magnus

AU - Lindtner, Jurij

AU - Collins, John

AU - Thürlimann, Beat

AU - Holmberg, Stig

AU - Veronesi, Andrea

AU - Marini, Giovanni

AU - Goldhirsch, Aron

PY - 2000/2

Y1 - 2000/2

N2 - Purpose: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. An analysis of the International (Ludwig) Breast Cancer Study Group (IBCSG) Trial V at a median follow-up of 11 years suggested that early initiation of adjuvant chemotherapy might improve outcome for premenopausal, node-positive patients whose tumors did not express any estrogen receptor (ER). Patients and Methods: We investigated the relationship between early initiation of adjuvant chemotherapy, ER status, and prognosis in 1,788 premenopausal, node-positive patients treated on IBCSG trials I, II, and VI. The disease-free survival for 599 patients (84 with ER-absent tumors) who commenced adjuvant chemotherapy within 20 days (early initiation) was compared with the disease-free survival for 1,189 patients (142 with ER-absent tumors) who started chemotherapy 21 to 86 days after surgery (conventional initiation). The median follow-up was 7.7 years. Results: Among patients with ER-absent tumors, the 10-year disease-free survival was 60% for the early initiation group compared with 34% for the conventional initiation group (226 patients; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.33 to 0.72; P = .0003]. This difference remained statistically significant in a Cox multiple regression analysis controlling for study group, number of positive nodes, tumor size, age, vessel invasion, and institution (HR, 0.60; 95% CI, 0.39 to 0.92; P = .019). Conversely, early initiation of chemotherapy did not significantly improve disease-free survival far patients with tumors expressing ER (1,562 patients; multiple regression HR, 0.93; 95% CI, 0.79 to 1.10; P = .40). Conclusion: In premenopausal patients with ER-absent tumors, early initiation of systemic chemotherapy after primary surgery might improve outcome. Further confirmatory studies are required before any widespread modification of current clinical practice. In premenopausal patients with tumors expressing some ER, gains from early initiation are unlikely to be clinically significant. (C) 2000 by American Society of Clinical Oncology.

AB - Purpose: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. An analysis of the International (Ludwig) Breast Cancer Study Group (IBCSG) Trial V at a median follow-up of 11 years suggested that early initiation of adjuvant chemotherapy might improve outcome for premenopausal, node-positive patients whose tumors did not express any estrogen receptor (ER). Patients and Methods: We investigated the relationship between early initiation of adjuvant chemotherapy, ER status, and prognosis in 1,788 premenopausal, node-positive patients treated on IBCSG trials I, II, and VI. The disease-free survival for 599 patients (84 with ER-absent tumors) who commenced adjuvant chemotherapy within 20 days (early initiation) was compared with the disease-free survival for 1,189 patients (142 with ER-absent tumors) who started chemotherapy 21 to 86 days after surgery (conventional initiation). The median follow-up was 7.7 years. Results: Among patients with ER-absent tumors, the 10-year disease-free survival was 60% for the early initiation group compared with 34% for the conventional initiation group (226 patients; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.33 to 0.72; P = .0003]. This difference remained statistically significant in a Cox multiple regression analysis controlling for study group, number of positive nodes, tumor size, age, vessel invasion, and institution (HR, 0.60; 95% CI, 0.39 to 0.92; P = .019). Conversely, early initiation of chemotherapy did not significantly improve disease-free survival far patients with tumors expressing ER (1,562 patients; multiple regression HR, 0.93; 95% CI, 0.79 to 1.10; P = .40). Conclusion: In premenopausal patients with ER-absent tumors, early initiation of systemic chemotherapy after primary surgery might improve outcome. Further confirmatory studies are required before any widespread modification of current clinical practice. In premenopausal patients with tumors expressing some ER, gains from early initiation are unlikely to be clinically significant. (C) 2000 by American Society of Clinical Oncology.

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