288P - Prognostic tools in early breast cancer: predicting benefit of adjuvant chemotherapy

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Breast Cancer, Early Stage
Pathology/Molecular Biology
Presenter Eileen Parkes
Authors E.E. Parkes1, C. Davidson2, A. Hussain2, C.R. James2, G.G. Hanna3
  • 1Northern Ireland Cancer Centre, BT9 7AB - Belfast/UK
  • 2Medical Oncology, Northern Ireland Cancer Centre, BT9 7AB - Belfast/UK
  • 3Centre For Cancer Research And Cell Biology, Queens University Belfast, BT9 7AB - Belfast/UK

Abstract

Introduction

Adjuvant chemotherapy (CT) in early breast cancer reduces the risk of mortality. However, absolute reductions in mortality can be small. For patient with low risk disease prognostic tools such as ‘Adjuvant! Online’ (AO) and ‘Predict’ (PD) can be used to estimate the benefit of adjuvant chemotherapy. We compare the survival gains estimated using AO and PD in routine clinical practice, assessing the characteristics of patients in which AO and PD disagree.

Methods

In a retrospective study using the hospital electronic database, the clinical and pathological details of all patients with early breast cancer referred for adjuvant therapy at the Northern Ireland Cancer Centre in a 3 month period in 2011 were collected and were entered in to AO and PD to assess percentage benefit (absolute reduction in mortality at 10 years) from CT. We categorised patients into three prognostic groups: those where risk from CT outweighs benefit (<2% predicted benefit), marginal benefit (2 to 5%) and significant benefit from CT (>5%) We excluded patients with metastatic disease at presentation, DCIS, a second primary breast cancer or receiving neo-adjuvant treatment.

Results

Of the 200 patients identified, 43 (21.5%) fell in to different prognostic groups depending on whether AO or PD was used to calculate benefit from CT. In total, AO suggested marginal or significant benefit in 69.8% of patients, compared to 60.4% using PD. Eight patients had “major” comorbidities, which is weighted only in AO, and were excluded in subsequent analysis. Of those without major comorbidities, AO offered at least 2% benefit in 80% of cases, and PD in only 57.1%. The majority (91.4%) of cases were ER positive, and node negative (82.9%). This difference was notable in women aged 65 or less, with 83.3% with >2% benefit using AO, and 61.1% using PD. AO estimates of benefit were on average 3.7% higher for this age group. HER2 status had little impact, with similar recommendations using either AO or PD.

Conclusions

This study highlights lack of concordance between two available online prognostic tools, notably in ER positive, node negative patients. For patients with a marginal benefit from CT, care must be used when making adjuvant treatment decisions.

Disclosure

All authors have declared no conflicts of interest.