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Impact of timing of adjuvant chemotherapy for early breast cancer: the Royal Marsden Hospital experience



The optimal time to deliver adjuvant chemotherapy has not been defined.


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.


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).


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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These data were presented at the ESMO Breast Cancer Symposium 2019.26

Author information




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.

Corresponding author

Correspondence to Alicia F. C. Okines.

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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.

Competing interests

The authors declare no competing interests.

Funding information

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).

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