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- Title
Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer.
- Authors
Berry DA; Cirrincione C; Henderson IC; Citron ML; Budman DR; Goldstein LJ; Martino S; Perez EA; Muss HB; Norton L; Hudis C; Winer EP; Berry, Donald A; Cirrincione, Constance; Henderson, I Craig; Citron, Marc L; Budman, Daniel R; Goldstein, Lori J; Martino, Silvana; Perez, Edith A
- Abstract
<bold>Context: </bold>Breast cancer estrogen-receptor (ER) status is useful in predicting benefit from endocrine therapy. It may also help predict which patients benefit from advances in adjuvant chemotherapy.<bold>Objective: </bold>To compare differences in benefits from adjuvant chemotherapy achieved by patients with ER-negative vs ER-positive tumors.<bold>Design, Setting, and Patients: </bold>Trial data from the Cancer and Leukemia Group B and US Breast Cancer Intergroup analyzed; patient outcomes by ER status compared using hazards over time and multivariate models. Randomized trials comparing (1): 3 regimens of cyclophosphamide, doxorubicin, and fluorouracil (January 1985 to April 1991); (2) 3 doses of doxorubicin concurrent with cyclophosphamide, with or without subsequent paclitaxel (May 1994 to April 1997); (3) sequential doxorubicin, paclitaxel, and cyclophosphamide with concurrent doxorubicin and cyclophosphamide followed by paclitaxel, and also 3-week vs 2-week cycles (September 1997 to March 1999). A total of 6644 node-positive breast cancer patients received adjuvant treatment.<bold>Main Outcome Measures: </bold>Disease-free and overall survival.<bold>Results: </bold>For ER-negative tumors, chemotherapy improvements reduced the relative risk of recurrence by 21%, 25%, and 23% in the 3 studies, respectively, and 55% comparing the lowest dose in the first study with biweekly cycles in the third study. Corresponding relative risk reductions for ER-positive tumors treated with tamoxifen were 9%, 12%, and 8% in the 3 studies, and 26% overall. The overall mortality rate reductions associated with chemotherapy improvements were 55% and 23% among ER-negative and ER-positive patients, respectively. All individual ER-negative comparisons and no ER-positive comparisons were statistically significant. Absolute benefits due to chemotherapy were greater for patients with ER-negative compared with ER-positive tumors: 22.8% more ER-negative patients survived to 5 years disease-free if receiving chemotherapy vs 7.0% for ER-positive patients; corresponding improvements for overall survival were 16.7% vs 4.0%.<bold>Conclusion: </bold>Among patients with node-positive tumors, ER-negative breast cancer, biweekly doxorubicin/cyclophosphamide plus paclitaxel lowers the rate of recurrence and death by more than 50% in comparison with low-dose cyclophosphamide, doxorubicin, and fluorouracil as used in the first study.
- Publication
JAMA: Journal of the American Medical Association, 2006, Vol 295, Issue 14, p1658
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.295.14.1658