306P - Outcome and prognostic factors in node-negative, early breast cancer patients receiving adjuvant FEC regimen: Who might be candidate for taxanes?

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Breast Cancer
Biological Therapy
Presenter RAHAL Soraya
Citation Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327
Authors R. Soraya, A. Gonçalves



Anthracycline-based adjuvant chemotherapy (CT) improves overall survival (OS) in operable breast cancer (BC) patients (pts). Additional benefits are provided by taxanes (TX) in node-positive pts, but no advantage in term of OS has been demonstrated in node-negative (NN) pts. We analyzed a large institutional population of NNBC pts receiving adjuvant FEC regimen with the following objectives: 1) to describe disease-free survival (DFS) and OS; 2) to identify poor-prognostic factors that may help to select high-risk pts who might be candidate to TX.


Between 1998 and 2008, 757 NNBC pts receiving adjuvant FEC (5FU 500 mg/m2, Epirubicin 75 or 100 mg/m2, cyclophosphamide 500 mg/m2) were identified from our institutional database. Features indicating adjuvant CT were pathological tumor size >15 mm, grade 3, peritumoral vascular invasion (PVI), no hormonal receptivity (ER and PR-, HR-), age <40. Since 2005, HER2+ EBC were given adjuvant trastuzumab (n = 38). Molecular subtypes were derived from ER, PR, HER2 IHC status and grade. Survival curves were generated using Kaplan-Meier method and compared using Log-rank test. Multivariate analysis was performed using Cox regression model


After a median follow-up of 70 months, 69 DFS events and 39 deaths were observed, for 5-year DFS and OS of 90.6% (CI95%, 88.2-93.1) and 95.1% (CI95%, 93.3-96.9), respectively. Univariate analysis identified PVI (p = 0.0007), grade 3 (p = 0.0138), PR-negative (p = 0.0293) and molecular subtypes (p = 0.0003) as prognostic factors for DFS. No significant prognostic impact was observed for HER2+ BC. By multivariate analysis, PVI and grade 3 maintained a significant and independent prognostic impact. In an alternative multivariate model where ER, PR and grade were replaced by molecular subtypes, luminal B-like (HR = 4.21, CI95%, 1.955-9.055, p = 0.0002) and basal-like (HR = 2.54, CI95%, 1.173-5.497, p = 0.018) subtypes were significantly associated with reduced DFS.


Overall, NNBC pts receiving adjuvant FEC have excellent 5-year DFS and OS. PVI, luminal B-like and basal-like subtypes identify pts with a higher risk of treatment failure, who might be candidate to TX.


All authors have declared no conflicts of interest.