Arlindo R Ferreira1, Ana Palha2, Lurdes Correia2, Pedro Filipe2, Vasco Rodrigues2, Ana Miranda3, Rosário André3, João Fernandes4, Joaquim Gouveia4, José L Passos-Coelho5, António Moreira6, Margarida Brito6, Joana Ribeiro7, Otto Metzger-Filho8, Nancy U Lin8, Luís Costa1, Inês Vaz-Luis9. 1. Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal. 2. Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal. 3. Registo Oncológico Regional do Sul, Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal. 4. Hospitais CUF Lisboa, R. Mário Botas, 1998-018 Lisbon, Portugal. 5. Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisbon, Portugal. 6. Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal. 7. Fundação Champalimaud, Av. Brasília, 1400-038 Lisbon, Portugal. 8. Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. 9. Institut Gustave Roussy, Unit INSERM 981, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. Electronic address: Ines-Maria.Vaz-Duarte-Luis@gustaveroussy.fr.
Abstract
BACKGROUND: Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM). PATIENTS AND METHODS: This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions. RESULTS: Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37-0.81). CONCLUSION: AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
BACKGROUND: Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM). PATIENTS AND METHODS: This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions. RESULTS: Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37-0.81). CONCLUSION: AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.