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Adjuvant chemotherapy improved outcomes after isolated locoregional breast cancer recurrence
Adjuvant chemotherapy extended DFS among patients with completely resected isolated locoregional recurrences of breast cancer, according to results of an open-label, randomized study.
The benefit was particularly apparent among patients with ER-negative recurrences.
Isolated locoregional recurrences of breast cancer often are associated with increased risk for distant metastasis and breast cancer-specific mortality, according to background information in the study.
Researchers conducted the current study to assess whether adjuvant chemotherapy improves outcomes of patients with histologically proven and completely excised isolated locoregional recurrences after unilateral breast cancer. All 162 patients had undergone a mastectomy or lumpectomy with clear surgical margins.
Researchers randomly assigned 85 patients to investigator-selected chemotherapy (a multidrug regimen for at least four courses was recommended) and 77 patients to no chemotherapy. Women with ER-positive isolated locoregional recurrences received adjuvant endocrine therapy; women with microscopically involved surgical margins underwent mandated radiation therapy, and anti-HER–2 therapy was optional.
At median follow-up of 4.9 years, fewer patients assigned chemotherapy experienced DFS events (28% vs. 44%). Five-year DFS was 69% among those assigned chemotherapy and 57% among those who did not receive chemotherapy (HR=0.59; 95% CI, 0.35-0.99).
Researchers found adjuvant chemotherapy was significantly more effective in women with ER-negative isolated locoregional recurrences (P=.046), but the differences in DFS based on ER status of the primary tumor were not statistically significant (P=.43).
Twelve patients (15%) assigned chemotherapy experienced serious adverse events. They included neutropenia, febrile neutropenia and intestinal infection.
Disclosure: The study was funded by the US Department of Health and Human Services, the Swiss Group for Clinical Cancer Research, the Frontier Science and Technology Research Foundation, the Australian and New Zealand Breast Cancer Trials Group, the Swedish Cancer Society, Oncosuisse, the Cancer Association of South Africa and the Foundation for Clinical Research of Eastern Switzerland.