Factors Determining Anthracycline Use in Hormone Receptor Positive, Early-Stage Breast Cancer

Abstract

In this study we investigated factors associated with prescribing patterns for an anthracycline-based chemotherapy in hormone receptor-positive stage I to III breast cancer. We carried out a retrospective analysis of the Michigan Breast Oncology Quality Initiative data set of 17,788 women with stage I to III estrogen receptor/progesterone receptor-positive HER2/neu-negative invasive breast cancer. Patients with a high recurrence score and lymph node-positive status were just as likely to receive an anthracycline as a nonanthracycline-based regimen. Background: Anthracyclines are associated with significant toxicities whereas nonanthracyclines have proven to be better tolerated. A 21-gene assay allows clinicians to predict who will not benefit from adjuvant chemotherapy and avoid systemic toxicities. Physicians are using the recurrence score to guide chemotherapy selection, despite the lack of evidence. In this study we examined factors associated with prescribing patterns for an anthracycline-based chemotherapy in hormone receptor-positive stage I to III breast cancer. Materials and Methods: This was a retrospective study using the Michigan Breast Oncology Quality Initiative data set (February 1, 2006 to December 31, 2015. Women with histologically confirmed stage I to III invasive breast cancer with estrogen receptor and/or progesterone receptorpositive, HER2/neu-negative receptor status were included. We used c 2 analysis to determine associations of these characteristics with the 21-gene assay score and anthracycline use. Results: A total of 17,788 patients were evaluated. Most tumors were stage I (60%). Most procedures were lumpectomy with radiation (66%). Anthracyclines were used more often in stage III patients (69%), younger patients (40% for patients younger than 65 years), and those with higher 21-gene recurrence scores. Patients with low recurrence scores were more likely to receive anthracyclines if lymph node-positive (10%) than if lymph node-negative (1%; P < .001). Patients with high recurrence scores and lymph node-positive status were just as likely to receive an anthracycline-based as a nonanthracycline-based regimen (47.5% vs. 49.2%; P ¼ .89). Conclusion: These data indicate that medical oncologists might be anticipating the results of Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer study (TAILORx) and the Clinical Outcomes in ERþHER2-node-positive Breast Cancer Patients Who Were Treated According to the Recurrence Score Results: Evidence From a Large Prospectively Designed Registry (RxPonder) trials and are avoiding the potential serious complications associated with anthracycline treatment in patients least likely to receive benefit.

Profile, treatment patterns, and influencing factors of anthracycline use in breast cancer patients in China: A nation‐wide multicenter study

“…Unfortunately, few studies addressed this question, and more investigations are needed. In a study on hormone receptor‐positive early‐stage breast cancer, ABC was administered more often to young patients (40% of the patients <65 years), to the ones with stage III disease (69%) or higher 21‐gene recurrence scores, and positive lymph nodes encouraged the selection of ABC in the absence of high recurrence scores 9 . As regard the clinicopathological characteristics, the results of this study were highly compatible with that of our analysis.…”

“…Currently, regimens that include doxorubicin are listed in The National Comprehensive Cancer Network guidelines as an alternative option in all risk levels and stages of breast cancer except for the lowest risk and early‐stage breast cancer 3 . However, the use of other anticancer agents has led to the study of a greater number of combinations of chemotherapeutic drugs in specific patients, and consequently anthracycline‐based chemotherapy (ABC) has been in decline for decades 8,9 . Additionally, anthracyclines exert remarkable adverse effects and among them, cardiotoxicity is the main one.…”

Anthracyclines in the treatment of patients with early breast cancer

“…Consistent with the available evidence, a retrospective real-world analysis including 17 788 patients with HR-positive, HER2-negative early BC candidate to receive chemotherapy based on a 21-gene assay showed that anthracyclines are prescribed more often to younger patients, with higher-stage tumors and with higher 21-gene recurrence scores, suggesting the tendency in clinical practice of avoiding the potential serious complications associated with anthracycline treatment in patients least likely to receive benefit. 39 …”

Recurrencia y características clínico patológicas en los grupos de riesgo establecidos por Oncotype Dx, original y TAILORx, en cáncer de mama temprano

“…Los autores señalaron que la prescripción de las antraciclinas fue más frecuente aún en pacientes con RB o RI con ganglios positivos; sin embargo, el estado ganglionar axilar no parece haber sido un factor de selección del tratamiento en el grupo con RA. 26 La esencia del estudio publicado por Paik 18 fue validar, de manera prospectiva, la capacidad de la prueba de 21 genes para predecir el riesgo de recurrencia en casos con ganglios negativos y RE positivos tratados con tamoxifeno adyuvante, sus resultados rápidamente derivaron en considerar que el grupo RA debía recibir quimio y endocrinoterapia y, ante la carencia de información, la quimioterapia seguida de terapia hormonal era indicada en casos con RI y ganglios positivos. 27 TAILORx 20 fue un ensayo controlado, prospectivo, el cual analizó 10,253 mujeres de 18 a 75 años, con CM, RH positivos, HER2 negativo y ganglios axilares negativos, el cual fue dirigido para evaluar la no inferioridad de la terapia endocrina frente a la quimioterapia adyuvante en casos con RI (puntuación [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”