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- Title
Relative effectiveness of adjuvant chemotherapy for invasive lobular compared with invasive ductal carcinoma of the breast.
- Authors
Marmor, Schelomo; Hui, Jane Yuet Ching; Huang, Jing Li; Kizy, Scott; Beckwith, Heather; Blaes, Anne H.; Rueth, Natasha M.; Tuttle, Todd M.
- Abstract
<bold>Background: </bold>Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) have distinct clinical, pathologic, and genomic characteristics. The objective of the current study was to compare the relative impact of adjuvant chemotherapy on the survival of patients with ILC versus those with IDC.<bold>Methods: </bold>Women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 1 (HER2) -negative, stage I/II IDC and ILC who received endocrine therapy were identified from the 2000 to 2014 California Cancer Registry. Patient, tumor, and treatment characteristics were collected. Ten-year overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional-hazards modeling.<bold>Results: </bold>In total, 32,997 women with IDC and 4638 with ILC were identified. The receipt of chemotherapy significantly decreased during the study for both subtypes. For patients with IDC, the 10-year OS rate was 95% among those who received endocrine therapy alone versus 93% (P < .01) among those who received endocrine therapy plus chemotherapy. For patients with ILC, the 10-year OS rate was 94% among those who received endocrine therapy alone versus 92% (P < .01) among those who received endocrine therapy plus chemotherapy. After adjusting for patient and treatment factors, adjuvant chemotherapy was significantly associated with a decreased 10-year hazard of death for patients with IDC (hazard ratio, 0.83; 95% confidence interval, 0.74-0.92). In contrast, adjuvant chemotherapy was not independently associated with the adjusted 10-year hazard of death for patients with ILC (hazard ratio, 1.14; 95% confidence interval, 0.90-1.46).<bold>Conclusions: </bold>Adjuvant chemotherapy was not associated with improved OS for patients with ER-positive, HER2-negative, stage I/II ILC. Avoidance of ineffective chemotherapy will markedly reduce the adverse effects and economic burden of breast cancer treatment for a large proportion of patients with breast cancer. Cancer 2017;123:3015-21. © 2017 American Cancer Society.
- Subjects
CANCER chemotherapy; LOBULAR carcinoma; DUCTAL carcinoma; BREAST cancer treatment; HORMONE receptor positive breast cancer; TUMOR proteins; KAPLAN-Meier estimator; PROPORTIONAL hazards models; THERAPEUTICS; ANTINEOPLASTIC agents; PROTEIN metabolism; BREAST cancer chemotherapy; AGE distribution; BREAST cancer; BREAST tumors; CELL receptors; COMBINED modality therapy; COMPARATIVE studies; MASTECTOMY; RESEARCH methodology; MEDICAL cooperation; RADIOTHERAPY; RESEARCH; SOCIAL classes; SURVIVAL; TUMOR classification; LUMPECTOMY; EVALUATION research; TREATMENT effectiveness; ACQUISITION of data; RETROSPECTIVE studies; TUMOR grading
- Publication
Cancer (0008543X), 2017, Vol 123, Issue 16, p3015
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.30699