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- Title
The Influence of Adjuvant Systemic Regimens on Contralateral Breast Cancer Risk and Receptor Subtype.
- Authors
Kramer, Iris; Schaapveld, Michael; Oldenburg, Hester S A; Sonke, Gabe S; McCool, Danielle; Leeuwen, Flora E van; Vijver, Koen K Van de; Russell, Nicola S; Linn, Sabine C; Siesling, Sabine; Oordt, C Willemien Menke-van der Houven van; Schmidt, Marjanka K; van Leeuwen, Flora E; Van de Vijver, Koen K; Menke-van der Houven van Oordt, C Willemien
- Abstract
<bold>Background: </bold>An increasing number of breast cancer (BC) survivors are at risk of developing contralateral breast cancer (CBC). We aimed to investigate the influence of various adjuvant systemic regimens on, subtype-specific, risk of CBC.<bold>Methods: </bold>This population-based cohort study included female patients diagnosed with first invasive BC between 2003 and 2010; follow-up was complete until 2016. Clinico-pathological data were obtained from the Netherlands Cancer Registry and additional data on receptor status through linkage with PALGA: the Dutch Pathology Registry. Cumulative incidences (death and distant metastases as competing risk) and hazard ratios (HRs) were estimated for all invasive metachronous CBC and CBC subtypes.<bold>Results: </bold>Of 83 144 BC patients, 2816 developed a CBC; the 10-year cumulative incidence was 3.8% (95% confidence interval [CI] = 3.7% to 4.0%). Overall, adjuvant chemotherapy (HR = 0.70, 95% CI = 0.62 to 0.80), endocrine therapy (HR = 0.46, 95% CI = 0.41 to 0.52), and trastuzumab with chemotherapy (HR = 0.57, 95% CI = 0.45 to 0.73) were strongly associated with a reduced CBC risk. Specifically, taxane-containing chemotherapy (HR = 0.48, 95% CI = 0.36 to 0.62) and aromatase inhibitors (HR = 0.32, 95% CI = 0.23 to 0.44) were associated with a large CBC risk reduction. More detailed analyses showed that endocrine therapy statistically significantly decreased the risk of estrogen receptor (ER)-positive CBC (HR = 0.41, 95% CI = 0.36 to 0.47) but not ER-negative CBC (HR = 1.32, 95% CI = 0.90 to 1.93) compared with no endocrine therapy. Patients receiving chemotherapy for ER-negative first BC had a higher risk of ER-negative CBC from 5 years of follow-up (HR = 2.84, 95% CI = 1.62 to 4.99) compared with patients not receiving chemotherapy for ER-negative first BC.<bold>Conclusion: </bold>Endocrine therapy, chemotherapy, as well as trastuzumab with chemotherapy reduce CBC risk. However, each adjuvant therapy regimen had a different impact on the CBC subtype distribution. Taxane-containing chemotherapy and aromatase inhibitors were associated with the largest CBC risk reduction.
- Subjects
HORMONE receptor positive breast cancer; BREAST cancer; HORMONE therapy; ESTROGEN receptors; AROMATASE inhibitors; COMPETING risks
- Publication
JNCI: Journal of the National Cancer Institute, 2019, Vol 111, Issue 7, p709
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djz010