310P - Preventive tamoxifen after ductal carcinoma in situ (DCIS) diagnosis according to age and ethnicity

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Early Stage
Cancer Aetiology, Epidemiology, Prevention
Presenter Angela Toss
Citation Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327
Authors A. Toss1, A. Berger2, F. Guiles3, J.A. Sendecki4, N. Simone5, P.R. Anne5, T. Avery6, R. Jaslow6, J. Palazzo7, M. Lazar2, T. Tsangaris2, M. Cristofanilli6
  • 1Department Of Oncology, Haematology And Respiratory Diseases, University of Modena and Reggio Emilia, 41124 - Modena/IT
  • 2Department Of Surgery, Thomas Jefferson University Hospital, Philadelphia/US
  • 3Oncology Data Services Department (cancer Registry), Thomas Jefferson University Hospital, Philadelphia/US
  • 4Division Of Biostatics, Thomas Jefferson University Hospital, Philadelphia/US
  • 5Department Of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia/US
  • 6Department Of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia/US
  • 7Department Of Pathology, Thomas Jefferson University Hospital, Philadelphia/US

Abstract

Aim

The primary aim in the management of DCIS is the prevention of ipsilateral and contralateral invasive tumors. African American (AA) women and younger age experience a higher incidence of disease recurrence and worse overall survival. The use of endocrine treatment significantly reduces recurrence rate and contralateral disease in hormone receptor positive (HR+) DCIS, but with significant costs and side effects. We analyzed the efficacy of tamoxifen (TAM) as preventive strategy and outcome according to age and ethnicity in DCIS patients.

Methods

In the Thomas Jefferson University Tumor Registry, we identified 341 patients with ER and/or PR positive DCIS or microinvasive carcinoma treated between 2008 and 2013. Associations between recurrence and use of preventive TAM were assessed according to patient age and ethnicity.

Results

Of 341 HR+ tumors, 289 were DCIS and 30 microinvasive carcinoma. Moreover, 222 (65.1%) patients were white (211 Caucasian, 5 Hispanic and 6 unknown), 109 (32%) were non-white (82 AA and 27 Asian) and 10 (2.9%) unknown. Median age was 60 years (range 34-92); 183 (53.7%) patients were aged less than 60 years and 158 (46.3%) over 61. Preventive TAM was administered to 139 (31.2%) patients. After a median follow-up of 2.77 years (range 0-5.65), 19 patients developed recurrence, 17 of which were in situ. Patients treated with TAM were less likely to developed recurrence (HR 0.30, p 0.0578). Hazard of recurrence was higher within non-white (HR 0.38) than white (HR 0.20), even if it did not reach significance (p 0.628). Similarly, hazard of recurrence was not significantly different between age groups (p 0.459) but the hazards ratio within the younger (HR 0.56) was higher than older patients (HR 0.20).

Conclusions

Overall, our analysis confirms that TAM reduces recurrence rates in DCIS. The small recurrence rate in our sample can explain the only marginally significant p-values in the analysis. Even if the effect of TAM is not significantly different among age and ethnic groups, a greater impact in white and older patients was identified. This underlines the need for a widely use of preventive endocrine treatment in these subgroups and suggests that, despite the HR expression, non-white and younger patients may have a more aggressive disease biology requiring future evaluation of further novel prognostic molecular biomarkers.

Disclosure

All authors have declared no conflicts of interest.