Does time to adjuvant chemotherapy (TTC) affect outcomes in patients with triple-negative breast cancer?

Pomponio, Maria; Keele, Luke; Fox, Kevin R.; Clark, Amy S.; Matro, Jennifer M.; Shulman, Lawrence N.; Tchou, Julia

doi:10.1007/s10549-019-05282-0

Cited by 10 publications

(11 citation statements)

References 18 publications

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“…In contrast with the previously mentioned studies, a recent propensity score‐matched single‐center study in 724 TNBC patients observed no difference in disease‐free survival and overall survival between patients who had TTC within 30, 32–42, 43–56 or beyond 56 days . The difference in results with the current study might be due to the smaller sample size or absence of stratified analyses for type of surgery.…”

Section: Discussioncontrasting

confidence: 99%

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple‐negative breast cancer

Heeg

Mheen

Maaren

et al. 2019

Intl Journal of Cancer

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Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22-2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84-1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted.Additional Supporting Information may be found in the online version of this article.

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Section: Discussioncontrasting

confidence: 99%

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple‐negative breast cancer

Heeg

Mheen

Maaren

et al. 2019

Intl Journal of Cancer

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“…The optimal TTC remains uncertain for BC patients 8 . The median TTC of our study cohort was 20 (IQR 13-29) days, which was relatively shorter than other studies [9][10][11][12]14,15 . Till now, a 4-week interval from surgery to chemotherapy was most frequently adopted when assessing the impact of TTC 19 .…”

Section: Discussioncontrasting

confidence: 52%

Prolonged Time to Adjuvant Chemotherapy Initiation Was Associated with Worse Disease Outcome in Triple Negative Breast Cancer Patients

Cai

Tong

Zhu

et al. 2020

Sci Rep

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the optimal time to adjuvant chemotherapy (ttc) for breast cancer (Bc) patients remains uncertain. Herein, we aim to evaluate the association between TTC and prognosis among different subtypes in modern era of adjuvant chemotherapy. Bc patients receiving operation and adjuvant chemotherapy between January 2009 and December 2015 were included. Enrolled patients were categorized into TTC ≤4 weeks and >4 weeks groups. Relapse-free survival (RFS) and overall survival (OS) were compared according to TTC and analyzed among different BC molecular subtypes. A total of 2611 patients were included. elder age (P = 0.005), more comorbidities (P <0.001), breast-conserving surgery (P = 0.001), non-invasive ductal carcinoma (P = 0.012), and HER2-positivity (P <0.001) were associated with prolonged TTC. Among whole BC population, no significant difference was observed between two TTC groups in terms of RfS (P = 0.225) or OS (P = 0.355). However, for triple negative (TNBC) patients, TTC >4 weeks was independently related with worse RFS (5-year RFS 81.9% vs 89.3%; HR, 1.89; 95% CI, 1.09 to 3.27; P = 0.024) and OS (5-year OS 84.0% vs 94.0%; HR, 2.49; 95% CI, 1.30 to 4.76; P = 0.006) compared with those ttc ≤4 weeks. Prolonged TTC >4 weeks after BC surgery was not associated with worse survival outcomes in the whole BC patients. However, TTC >4 weeks may increase risk of relapse or death in TNBC patients, which deserves further clinical evaluation. Breast cancer (BC) is the most common malignancy in women worldwide 1. Chemotherapy is an essential part of systemic treatment in early BC patients. Adjuvant chemotherapy has been demonstrated to decrease the risk of disease recurrence by 30% to 50%, which corresponded to an absolute overall survival (OS) benefit of 10% 2,3. As a heterogeneous disease, BC is classified into different molecular subtypes according to its estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 status 4. Triple negative breast cancer (TNBC) is one of the subtypes which is defined by the absence of ER, PR and HER2 overexpression. Representing 15% of BC, TNBC is featured by its aggressive biology with a higher risk of local and distant relapses 5. Currently, chemotherapy is the only routinely used effective systemic treatment for TNBC patients. The timing of adjuvant chemotherapy initiation after breast cancer surgery may influence adjuvant treatment efficacy. Preclinical studies in animal models suggested that adjuvant chemotherapy should be applied as early as possible following the removal of tumor so as to gain the greatest benefit 6,7. However, the optimal interval from definitive surgery to the initiation of adjuvant chemotherapy (time to adjuvant chemotherapy, TTC) remains uncertain 8. TTC intervals reported in previous studies ranged from 2 to 12 weeks 8-12. A meta-analysis showed that each 4-week delay in TTC would lead to a 15% decrease in OS and a 16% decrease in disease-free survival (DFS), respectively 13. Moreover, the influence of chemotherapy...

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“…La poursuite du traitement est impossible en raison du risque de contamination des autres patientes, du personnel hospitalier, médical et para médical, du contact avec les personnes qui les transportent [3] , [4] , [5] , [6] , [7] .…”

Section: La Pratique Médicaleunclassified

L’expertise médicale au temps des pandémies : l’exemple des cancers

Salmon¹,

Buffet²,

Esteve

2020

Médecine & Droit

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Does time to adjuvant chemotherapy (TTC) affect outcomes in patients with triple-negative breast cancer?

Cited by 10 publications

References 18 publications

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple‐negative breast cancer

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple‐negative breast cancer

Prolonged Time to Adjuvant Chemotherapy Initiation Was Associated with Worse Disease Outcome in Triple Negative Breast Cancer Patients

L’expertise médicale au temps des pandémies : l’exemple des cancers

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