Abstract
Background
The optimal time to deliver adjuvant chemotherapy has not been defined.
Methods
A retrospective study of consecutive patients receiving adjuvant anthracycline and/or taxane 1993–2010. Primary endpoint included 5-year disease-free survival (DFS) in patients commencing chemotherapy <31 versus ≥31 days after surgery. Secondary endpoints included 5-year overall survival (OS) and sub-group analysis by receptor status.
Results
We identified 2003 eligible patients: 1102 commenced chemotherapy <31 days and 901 ≥31 days after surgery. After a median follow-up of 115 months, there was no difference in 5-year DFS rate with chemotherapy <31 compared to ≥31 days after surgery in the overall population (81 versus 82% hazard ratio (HR) 1.15, 95% confidence interval (95% CI) 0.92–1.43, p = 0.230). The 5-year OS rate was similar in patients who received chemotherapy <31 or ≥31 days after surgery (90 versus 91%, (HR 1.21, 95% CI 0.89–1.64, p = 0.228). For 250 patients with triple-negative breast cancer OS was significantly worse in patients who received chemotherapy ≥31 versus <31 days (HR = 2.18, 95% CI 1.11–4.30, p = 0.02).
Discussion
Although adjuvant chemotherapy ≥31 days after surgery did not affect DFS or OS in the whole study population, in TN patients, chemotherapy ≥31 days after surgery significantly reduced 5-year OS; therefore, delays beyond 30 days in this sub-group should be avoided.
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Okines, A. F. C., Kipps, E., Irfan, T., Coakley, M., Aggelis, V., Asare, B. et al. Impact of delayed adjuvant chemotherapy: the Royal Marsden Hospital (RMH) experience. Ann. Oncol. 30, iii28 (2019).
Acknowledgements
These data were presented at the ESMO Breast Cancer Symposium 2019.26
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A.F.C.O. collected data and wrote the manuscript. E.K., T.I., M.C. and V.A. collected data and edited/approved the manuscript. B.A. and K.M. performed the statistical analyses and approved the manuscript. G.W. collected data and approved the manuscript. A.R., S.R.D.J., M.P. and N.C.T. provided data and edited/approved the manuscript. I.E.S. designed the study and edited/approved the manuscript.
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The study was approved by the RM audit committee and ethics approval and consent were not required. The study was performed in accordance with the Declaration of Helsinki
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The data are available on request to the corresponding author.
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The authors declare no competing interests.
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We wish to acknowledge the support of the Royal Marsden NIHR Biomedical Research Centre for Cancer.
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Okines, A.F.C., Kipps, E., Irfan, T. et al. Impact of timing of adjuvant chemotherapy for early breast cancer: the Royal Marsden Hospital experience. Br J Cancer 125, 299–304 (2021). https://doi.org/10.1038/s41416-021-01428-4
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DOI: https://doi.org/10.1038/s41416-021-01428-4