Adjuvant chemotherapy is associated with an overall survival benefit regardless of age in ER+/HER2- breast cancer pts with 1-3 positive nodes and oncotype DX recurrence score 20 to 25: an NCDB analysis.

ER+ breast cancer HER2- breast cancer adjuvant (chemo)radiotherapy breast cancer chemotherapy oncotype survival

Journal

Frontiers in oncology
ISSN: 2234-943X
Titre abrégé: Front Oncol
Pays: Switzerland
ID NLM: 101568867

Informations de publication

Date de publication:
2023
Historique:
received: 03 12 2022
accepted: 11 04 2023
medline: 12 5 2023
pubmed: 12 5 2023
entrez: 11 5 2023
Statut: epublish

Résumé

The RxPONDER trial found that among breast cancer patients with estrogen receptor positive (ER+) breast cancer, 1-3 positive axillary nodes, and a recurrence score of ≤25, only pre-menopausal women benefitted from adjuvant chemoendocrine therapy; postmenopausal women with similar characteristic did not benefit from adjuvant chemotherapy. We aimed to replicate the RxPonder trial using a larger patient cohort with real world data to determine whether a RS threshold existed where adjuvant chemotherapy was beneficial regardless of age. The National Cancer Database (NCDB) was queried for women with ER+, human epidermal growth factor receptor 2 (HER2) negative breast cancer, 1-3 positive axillary nodes, and RS ≤25 who received endocrine (ET) only or chemo-endocrine therapy (CET). Cox regression interaction was explored between CET and age as a surrogate for menopausal status. The final analytic cohort included 28,427 eligible women: 7,487 (26.3%) received adjuvant CET and 20,940 (73.7%) ET. In the entire cohort, RS had a normal distribution, with a median score of 14. After correcting for demographic and clinical variables, a threshold effect was observed with RS >20 being associated with a significantly inferior overall survival (OS) (P value range: < 0.001-0.019). In women with RS of 20-25, CET was associated with a significant improvement in OS compared to ET alone, regardless of age (age <=50: HR = 0.334, P=0.002; age>50: HR=0.521, P=0.019). Among women with ER+/HER2- breast cancer with 1-3 positive nodes, and a RS of 20-25-in contrast to the RxPONDER trial-we observed that CET was associated with an OS benefit in women regardless of age.

Sections du résumé

Background UNASSIGNED
The RxPONDER trial found that among breast cancer patients with estrogen receptor positive (ER+) breast cancer, 1-3 positive axillary nodes, and a recurrence score of ≤25, only pre-menopausal women benefitted from adjuvant chemoendocrine therapy; postmenopausal women with similar characteristic did not benefit from adjuvant chemotherapy. We aimed to replicate the RxPonder trial using a larger patient cohort with real world data to determine whether a RS threshold existed where adjuvant chemotherapy was beneficial regardless of age.
Methods UNASSIGNED
The National Cancer Database (NCDB) was queried for women with ER+, human epidermal growth factor receptor 2 (HER2) negative breast cancer, 1-3 positive axillary nodes, and RS ≤25 who received endocrine (ET) only or chemo-endocrine therapy (CET). Cox regression interaction was explored between CET and age as a surrogate for menopausal status.
Results UNASSIGNED
The final analytic cohort included 28,427 eligible women: 7,487 (26.3%) received adjuvant CET and 20,940 (73.7%) ET. In the entire cohort, RS had a normal distribution, with a median score of 14. After correcting for demographic and clinical variables, a threshold effect was observed with RS >20 being associated with a significantly inferior overall survival (OS) (P value range: < 0.001-0.019). In women with RS of 20-25, CET was associated with a significant improvement in OS compared to ET alone, regardless of age (age <=50: HR = 0.334, P=0.002; age>50: HR=0.521, P=0.019).
Conclusion UNASSIGNED
Among women with ER+/HER2- breast cancer with 1-3 positive nodes, and a RS of 20-25-in contrast to the RxPONDER trial-we observed that CET was associated with an OS benefit in women regardless of age.

Identifiants

DOI: 10.3389/fonc.2023.1115208 PMID: 37168373 PMC: PMC10165881
pubmed: 37168373
doi: 10.3389/fonc.2023.1115208
pmc: PMC10165881
doi:

Types de publication

Journal Article

Langues

eng

Pagination

1115208

Informations de copyright

Copyright © 2023 Stabellini, Cao, Towe, Luo, Amin and Montero.

Déclaration de conflit d'intérêts

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Auteurs

Nickolas Stabellini (N)

Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Division of Hematology and Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Lifen Cao (L)

Division of Hematology and Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Christopher W Towe (CW)

Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Xun Luo (X)

Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Amanda L Amin (AL)

Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Division of Surgical Oncology, Department of Surgery, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Alberto J Montero (AJ)

Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Division of Hematology and Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Classifications MeSH