263PD - Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer
| Date | 27 September 2014 |
| Event | ESMO 2014 |
| Session | Breast cancer, early stage |
| Topics | Anticancer Agents Breast Cancer Therapy Biological Therapy |
| Presenter | Alberto Farolfi |
| Citation | Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327 |
| Authors |
A. Farolfi, E. Scarpi, A. Schirone, S. Bravaccini, R. Maltoni, L. Cecconetto, S. Sarti, P. Serra, D. Amadori, A. Rocca
|
Abstract
Aim
The optimal time from surgery to commencing chemotherapy in early breast cancer (EBC) remains unclear. We assessed the influence of time to initiation of adjuvant chemotherapy (TTC) on the outcome of EBC patients enrolled onto a phase III clinical trial (NCT01031030).Methods
The relationship between TTC, calculated as the time (in weeks) from definitive surgery to initiation of adjuvant chemotherapy, and disease-free (DFS) or overall survival (OS) was assessed in 1066 EBC patients with rapidly proliferating tumors (thymidine labeling index > 3% or G3 or Ki67 > 20%), randomized to receive adjuvant chemotherapy with or without anthracyclines (epirubicin → CMF vs CMF → epirubicin vs CMF). DFS, OS and their 95% confidence intervals (95% CI) were calculated by the Kaplan-Meier method. Multivariate Cox analysis was performed in relation to nodal involvement, estrogen receptor and HER2 status, Ki67 value, type of adjuvant chemotherapy, menopausal status and tumor size.
Results
Information on TTC was available for 713 women. At a median follow-up of 105 months (range 2-188), a prolonged TTC resulted in a significant increase of 16% in the risk of relapse (95% CI 1.03–1.30, p = 0.016) in a multivariable Cox regression model (Table 1). The impact on OS was not significant. Using a backward elimination procedure, TTC, tumor size and nodal involvement remained significantly associated with DFS (Hazard ratio [HR] = 1.15, 95% CI 1.02-1.29, p = 0.018; HR = 1.44, 95% CI 1.08-1.92, p = 0.012; HR = 1.44, 95% CI 1.08-1.92, p = 0.012, respectively). Again, nodal involvement and Ki67 were associated with OS (HR = 1.66, 95% CI 1.11-2.49, p = 0.014; HR = 1.63, 95% CI 1.03-2.59, p = 0.039, respectively).
| DFS | OS | |||
|---|---|---|---|---|
| HR (95% CI) | p | HR (95% CI) | p | |
| TTC | 1.16 (1.03–1.30) | 0.016 | 1.14 (0.97–1.35) | 0.121 |
| Age | 0.99 (0.97–1.02) | 0.829 | 0.99 (0.96–1.03) | 0.615 |
| ER | ||||
| Positive | 1.00 | 1.00 | ||
| Negative | 1.20 (0.89–1.61) | 0.242 | 1.20 (0.78–1.84) | 0.397 |
| HER2 | ||||
| Positive | 1.00 | 1.00 | ||
| Negative | 0.99 (0.73–1.33) | 0.929 | 0.92 (0.60–1.42) | 0.713 |
| Lymph node status | ||||
| Negative | 1.00 | 1.00 | ||
| Positive | 1.53 (1.14–2.04) | 0.004 | 1.71 (1.13–2.59) | 0.011 |
| Menopausal status | ||||
| Premenopausal | 1.00 | 1.00 | ||
| Postmenopausal | 1.32 (0.85–2.04) | 0.219 | 1.56 (0.82–2.97) | 0.177 |
| Tumor size | ||||
| <2cm | 1.00 | 1.00 | ||
| ≥2 cm | 1.41 (1.05–1.88) | 0.020 | 1.44 (0.95–2.18) | 0.085 |
| Ki67 | ||||
| ≤20% | 1.00 | 1.00 | ||
| >20% | 1.06 (0.77–1.44) | 0.724 | 1.54 (0.96–2.48) | 0.073 |
| Treatment arm | ||||
| E»CMF | 0.72 (0.49–1.04) | 0.079 | 0.69 (0.41–1.16) | 0.161 |
| CMF»E | 0.79 (0.55–1.14) | 0.202 | 0.75 (0.45–1.25) | 0.273 |
| CMF | 1.00 | 1.00 |
Conclusions
Our results suggest that patients with rapidly proliferating EBC should be treated as soon as possible once their recovery from surgery is complete.
Disclosure
All authors have declared no conflicts of interest.