Paul Gaß1, Peter A Fasching1, Tanja Fehm2, Johann de Waal3, Mahdi Rezai4, Bernd Baier3, Gerold Baake5, Hans-Christian Kolberg6, Martin Guggenberger7, Mathias Warm8, Nadia Harbeck9, Rachel Wuerstlein9, Jörg-Uwe Deuker10, Peter Dall11, Barbara Richter12, Grischa Wachsmann13, Cosima Brucker14, Jan W Siebers15, Nikos Fersis16, Thomas Kuhn17, Christopher Wolf18, Hans-Walter Vollert19, Georg-Peter Breitbach20, Wolfgang Janni21, Robert Landthaler22, Andreas Kohls23, Daniela Rezek24, Thomas Noesselt25, Gunnar Fischer26, Stephan Henschen27, Thomas Praetz28, Volker Heyl29, Thorsten Kühn30, Thomas Krauss31, Christoph Thomssen32, Andre Hohn33, Hans Tesch34, Christoph Mundhenke35, Alexander Hein1, Claudia Rauh1, Christian M Bayer1, Adib Jacob36, Katja Schmidt36, Erik Belleville37, Peyman Hadji38, Sara Y Brucker39, Matthias W Beckmann40, Diethelm Wallwiener39, Sherko Kümmel41, Christian R Löhberg40. 1. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. 2. Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Germany; Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany. 3. Frauenklinik im Klinikum Dachau, Dachau, Germany. 4. Luisenkrankenhaus Düsseldorf, Düsseldorf, Germany. 5. Onkologische Praxis Pinneberg, Pinneberg, Germany. 6. Marienhospital Bottrop, Bottrop, Germany. 7. Klinikum Tuttlingen, Tuttlingen, Germany. 8. Brustzentrum, Universitäts-Frauenklinik Köln, Cologne, Germany; Brustzentrum, Klinken der Stadt Köln, Holweide, Cologne, Germany. 9. Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, und CCC, Munich, Germany. 10. Vinzenzkrankenhaus Hannover, Hanover, Germany. 11. Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany. 12. Elblandkliniken Meißen-Radebeul, Meißen, Germany. 13. Kreiskrankenhaus Böblingen, Böblingen, Germany. 14. Universitätsklinik für Frauenheilkunde, Paracelsus Medizinische Privatuniversität, Nuremberg, Germany. 15. Frauenklinik der St. Josefsklinik, Offenburg, Germany. 16. Frauenklinik, Klinikum Bayreuth, Bayreuth, Germany. 17. Karl-Olga-Krankenhaus, Stuttgart, Germany. 18. Medizinisches Zentrum Ulm, Ulm, Germany. 19. Klinikum Friedrichshafen, Friedrichshafen, Germany. 20. Gynäkologie und Geburtshilfe, Städtisches Klinikum, Neunkirchen, Germany. 21. Frauenklinik des Universitätsklinikums Ulm, Ulm, Germany. 22. Gynäkologische Praxis in der Kreisklinik Krumbach, Krumbach, Germany. 23. Evangelisches Krankenhaus Ludwigsfelde-Teltow, Teltow, Germany. 24. Marien-Hospital, Wesel, Germany. 25. Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Hameln-Pyrmont, Hameln, Germany. 26. Landkreis Mittweida Krankenhaus, Mittweida, Germany. 27. Johanniter Krankenhaus Genthin Stendal, Stendal, Germany. 28. Caritas-Krankenhaus, Bad Mergentheim, Germany. 29. Schwerpunkt-Medizin für minimal invasive Chirurgie, Senologie und Onkologie Mainz, Mainz, Germany. 30. Frauenklinik, Städtische Kliniken, Esslingen a.N., Germany. 31. Frauenklinik, Klinikum Passau, Passau, Germany. 32. Frauenklinik, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 33. Städtisches Krankenhaus Kiel, Kiel, Germany. 34. Onkologie Bethanien, Frankfurt/M., Germany. 35. Frauenklinik, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany. 36. Novartis Pharma GmbH, Nuremberg, Germany. 37. Clin-Sol GmbH, Würzburg, Germany. 38. Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt/M., Germany. 39. Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany. 40. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Frauenklinik, St. Theresien-Krankenhaus, Nuremberg, Germany. 41. Brustzentrum, Kliniken Essen Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany.
Abstract
BACKGROUND: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. METHODS: Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. RESULTS: In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. CONCLUSION: There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.
BACKGROUND: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. METHODS:Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. RESULTS: In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. CONCLUSION: There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.
Entities:
Keywords:
Breast cancer; Chemotherapy; Decision-making; Oncology; Postmenopausal
Authors: P A Fasching; T Fehm; S Kellner; J de Waal; M Rezai; B Baier; G Baake; H-C Kolberg; M Guggenberger; M Warm; N Harbeck; R Würstlein; J-U Deuker; P Dall; B Richter; G Wachsmann; C Brucker; J W Siebers; N Fersis; T Kuhn; C Wolf; H-W Vollert; G-P Breitbach; W Janni; R Landthaler; A Kohls; D Rezek; T Noesslet; G Fischer; S Henschen; T Praetz; V Heyl; T Kühn; T Krauß; C Thomssen; S Kümmel; A Hohn; H Tesch; C Mundhenke; A Hein; C Rauh; C M Bayer; A Jacob; K Schmidt; E Belleville; P Hadji; D Wallwiener; E-M Grischke; M W Beckmann; S Y Brucker Journal: Geburtshilfe Frauenheilkd Date: 2014-12 Impact factor: 2.915
Authors: Matthias W Beckmann; Cosima Brucker; Volker Hanf; Claudia Rauh; Mayada R Bani; Stefanie Knob; Sabrina Petsch; Stefan Schick; Peter A Fasching; Arndt Hartmann; Michael P Lux; Lothar Häberle Journal: Onkologie Date: 2011-06-15
Authors: Foluso O Ademuyiwa; Austin Miller; Tracey O'Connor; Stephen B Edge; Mangesh A Thorat; George W Sledge; Ellis Levine; Sunil Badve Journal: Breast Cancer Res Treat Date: 2011-01-01 Impact factor: 4.872
Authors: C M Perou; T Sørlie; M B Eisen; M van de Rijn; S S Jeffrey; C A Rees; J R Pollack; D T Ross; H Johnsen; L A Akslen; O Fluge; A Pergamenschikov; C Williams; S X Zhu; P E Lønning; A L Børresen-Dale; P O Brown; D Botstein Journal: Nature Date: 2000-08-17 Impact factor: 49.962
Authors: R Peto; C Davies; J Godwin; R Gray; H C Pan; M Clarke; D Cutter; S Darby; P McGale; C Taylor; Y C Wang; J Bergh; A Di Leo; K Albain; S Swain; M Piccart; K Pritchard Journal: Lancet Date: 2011-12-05 Impact factor: 79.321
Authors: G C Wishart; C D Bajdik; E Dicks; E Provenzano; M K Schmidt; M Sherman; D C Greenberg; A R Green; K A Gelmon; V-M Kosma; J E Olson; M W Beckmann; R Winqvist; S S Cross; G Severi; D Huntsman; K Pylkäs; I Ellis; T O Nielsen; G Giles; C Blomqvist; P A Fasching; F J Couch; E Rakha; W D Foulkes; F M Blows; L R Bégin; L J van't Veer; M Southey; H Nevanlinna; A Mannermaa; A Cox; M Cheang; L Baglietto; C Caldas; M Garcia-Closas; P D P Pharoah Journal: Br J Cancer Date: 2012-07-31 Impact factor: 7.640
Authors: Paul Gass; Michael Untch; Volkmar Müller; Volker Möbus; Christoph Thomssen; Lothar Häberle; Ramona Erber; Alexander Hein; Sebastian Michael Jud; Michael P Lux; Carolin C Hack; Arndt Hartmann; Hans-Christian Kolberg; Johannes Ettl; Diana Lüftner; Christian Jackisch; Matthias W Beckmann; Wolfgang Janni; Andreas Schneeweiss; Peter A Fasching; Naiba Nabieva Journal: Geburtshilfe Frauenheilkd Date: 2018-07-25 Impact factor: 2.915