Mattea Reinisch1, Oleg Gluz2, Beyhan Ataseven3, Jens-Uwe Blohmer4, Marek Budner5, Christine Dittmer-Grabowski1, Andreas Kohls6, Jutta Krocker7, Aylin Kümmel1, Friederike Hagemann1, Anna Rüland1, Alexander Traut8, Sherko Kümmel1. 1. Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany. 2. Bethesda Hospital, Breast Center Niederrhein, Mönchengladbach, Germany; West German Study Group, Mönchengladbach, Germany. 3. Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany. 4. Breast Center, Charité Hospital Berlin, Berlin, Germany. 5. Breast Unit, Helios Klinikum, Bad Saarow, Germany. 6. Breast Unit, Evangelisches Krankenhaus Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany. 7. Breast Unit, Sana Klinikum Berlin-Lichtenberg, Berlin, Germany. 8. Statistician, Kliniken Essen-Mitte, Essen, Germany.
Abstract
PURPOSE: Although dose-dense (dd) chemotherapy plays a fundamental role in the treatment of breast cancer (BC), a variety of trials have presented divergent survival results. Here, we present data of patients with more than 3 positive axillary lymph nodes (+aLN) receiving dd chemotherapy after a median follow-up period of 12.3 years. METHODS: In the years 1996-2000, 231 patients with invasive BC, ≥pN2a and no evidence of distant metastases were recruited to receive treatment A, i.e. dd 3 × epirubicin (E, 90 mg/m<sup>2</sup>) + paclitaxel (P, 175 mg/m<sup>2</sup>) every 2 weeks (q2w) followed by 3 × cyclophosphamide (C)/methotrexate/5-fluorouracil (CMF, 600/40/600 mg/m<sup>2</sup>, q2w), or treatment B, i.e. 4 × E + C (C, 600 mg/m<sup>2</sup>) q3w followed by 3 × CMF q3w. RESULTS: 113 patients in arm A and 113 patients in arm B were analysed after an updated median follow-up of 12.3 years. The median age was 55 years, with a median number of 6 +aLN, 50.4% had a T2 and 79.2% hormone receptor-positive BC. The disease-free survival (DFS) rate was 53.1% in arm A and 42.5% in arm B (adjusted p = 0.027). The overall survival (OS) rate was 54.9% in arm A and 48.7% in arm B (adjusted p = 0.058). In the multivariable analysis, the tumour burden was a significant predictor for DFS and OS. CONCLUSION: The adjuvant use of dd chemotherapy led to a statistically significant improvement of DFS after a follow-up of 12.3 years.
PURPOSE: Although dose-dense (dd) chemotherapy plays a fundamental role in the treatment of breast cancer (BC), a variety of trials have presented divergent survival results. Here, we present data of patients with more than 3 positive axillary lymph nodes (+aLN) receiving dd chemotherapy after a median follow-up period of 12.3 years. METHODS: In the years 1996-2000, 231 patients with invasive BC, ≥pN2a and no evidence of distant metastases were recruited to receive treatment A, i.e. dd 3 × epirubicin (E, 90 mg/m<sup>2</sup>) + paclitaxel (P, 175 mg/m<sup>2</sup>) every 2 weeks (q2w) followed by 3 × cyclophosphamide (C)/methotrexate/5-fluorouracil (CMF, 600/40/600 mg/m<sup>2</sup>, q2w), or treatment B, i.e. 4 × E + C (C, 600 mg/m<sup>2</sup>) q3w followed by 3 × CMF q3w. RESULTS: 113 patients in arm A and 113 patients in arm B were analysed after an updated median follow-up of 12.3 years. The median age was 55 years, with a median number of 6 +aLN, 50.4% had a T2 and 79.2% hormone receptor-positive BC. The disease-free survival (DFS) rate was 53.1% in arm A and 42.5% in arm B (adjusted p = 0.027). The overall survival (OS) rate was 54.9% in arm A and 48.7% in arm B (adjusted p = 0.058). In the multivariable analysis, the tumour burden was a significant predictor for DFS and OS. CONCLUSION: The adjuvant use of dd chemotherapy led to a statistically significant improvement of DFS after a follow-up of 12.3 years.
Entities:
Keywords:
Adjuvant dose-dense chemotherapy; Disease-free survival; Long-term follow-up; Node-positive early breast cancer; Overall survival
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