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Delayed adjuvant chemotherapy worsened outcomes in high-risk breast cancer
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Patients with late-stage, triple-negative and trastuzumab-treated HER-2–positive breast cancers demonstrated worse outcomes if the initiation of adjuvant chemotherapy was delayed, according to study results.
The analysis included 6,827 patients diagnosed with stage I to II (84.5%) or stage III (15.5%) breast cancer between 1997 and 2011.
Researchers classified patients as having a time to adjuvant chemotherapy ≤30 days (39.8%), 31 to 60 days (43.8%), and ≥61 days (16.4%) from surgery.
Median follow-up was 59.3 months. At this time, 21% of patients had died, 31.3% had experienced disease recurrence and 28.2% experienced distant recurrence.
Overall, researchers observed no differences in 5-year OS (P=.54), RFS (P=.67) and distant RFS (P=.49) based on time to initiation of adjuvant chemotherapy among all patients.
However, after adjustments for confounders, initiation of adjuvant chemotherapy ≥61 days after surgery was associated with increased risk for death compared with ≤30-day initiation (HR=1.19; 95% CI, 1.02-1.38).
Researchers also stratified results based on disease stage and breast cancer subtype.
The risk for distant RFS increased among patients with stage II disease who received adjuvant therapy 31 to 60 days (HR=1.18; 95% CI, 1.03-1.34) and ≥61 days (HR=1.2; 95% CI, 1.02-1.43) from surgery.
Patients with stage III disease who began adjuvant chemotherapy ≥61 days after surgery demonstrated increased risk for death (HR=1.76; 95% CI, 1.26-2.46), relapse (HR=1.34; 95% CI, 1.01-1.76) and distant relapse (HR=1.36; 95% CI, 1.02-1.8) compared with those who began adjuvant chemotherapy ≤30 days after surgery.
Hormone receptor-positive patients who received chemotherapy ≥61 days from surgery demonstrated increased risk for death compared with those who received chemotherapy ≤30 days from surgery (HR=1.29; 95% CI, 1.02-1.64). Researchers also reported increased mortality risk for patients with triple-negative breast cancer who were treated 31 to 60 days (HR=1.74; 95% CI, 1.32-2.29) and ≥61 days (HR=1.54; 95% CI, 1.09-2.18) from surgery compared with those who received chemotherapy ≤30 days after surgery.
Patients with HER-2–positive tumors who had previously been treated with trastuzumab (Herceptin, Genentech) experienced worse outcomes if they received adjuvant therapy ≥61 days after surgery compared with ≤30 days from surgery (HR=3.09; 95% CI. 1.49-6.39).
“Among patients with stage II and III breast cancer, triple-negative breast cancer and HER-2–positive tumors, every effort should be made to avoid postponing the initiation of adjuvant therapy,” the researchers concluded. “This may lead to an improvement in outcomes for these subsets of patients.”
Disclosure: The researchers report no relevant financial disclosures.
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