Omission of chemotherapy for low-grade, luminal A N1 breast cancer

Patterns of care and clinical outcomes

Waqar Haque, Vivek Verma, Sandra Hatch, Vicki Klimberg, E. Brian Butler, Bin S. Teh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Multiple ongoing randomized studies are assessing the impact of omission of chemotherapy (CT) in low-risk node-positive Luminal A breast. The goal of this investigation was to evaluate trends and practice patterns of adjuvant CT use in Luminal A pT1-3N1 breast cancer, along with determining the clinical benefit from adjuvant CT in this patient population. Methods: The National Cancer Data Base was queried (2004–2014) for women with pT1-3N1 luminal A invasive ductal carcinoma receiving adjuvant hormonal therapy (HT). Multivariable logistic regression ascertained factors associated with adjuvant CT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with CT/HT vs. HT alone, while sub-stratifying patients by age. Results: Of 8548 total patients, 5182 (61%) received CT/HT, while 3366 (39%) received HT alone. A steady rise in omission of adjuvant CT was observed, from 14% (2004–2005) to 41% (2012–2014). A decision not to use CT was more likely in more recent time periods, in older patients, at academic centers, following lumpectomy, and with lower T classification (p < 0.05 for all). CT was associated with higher OS in all patients (p < 0.001) and women ≤50 years old (p = 0.030), but not for ages 51–60 (p = 0.116), 61–70 (p = 0.222), or >70 (p = 0.239). Conclusions: Using CT for Luminal A N1 breast cancer is decreasing over time, primarily in older patients and at academic centers. Although CT is still associated with an OS advantage in all patients, subgroup analysis demonstrated no OS benefit in women >50 years of age. These results have implications on the ongoing randomized trials.

Original languageEnglish (US)
Pages (from-to)67-73
Number of pages7
JournalBreast
Volume41
DOIs
StatePublished - Oct 1 2018

Fingerprint

Breast Neoplasms
Drug Therapy
Adjuvant Chemotherapy
Survival
Therapeutics
Ductal Carcinoma
Segmental Mastectomy
Kaplan-Meier Estimate
Breast
Logistic Models
Databases
Population
Neoplasms

Keywords

  • Breast cancer
  • Chemotherapy
  • Luminal A
  • Lumpectomy
  • Mastectomy
  • Radiation therapy

ASJC Scopus subject areas

  • Surgery

Cite this

Omission of chemotherapy for low-grade, luminal A N1 breast cancer : Patterns of care and clinical outcomes. / Haque, Waqar; Verma, Vivek; Hatch, Sandra; Klimberg, Vicki; Butler, E. Brian; Teh, Bin S.

In: Breast, Vol. 41, 01.10.2018, p. 67-73.

Research output: Contribution to journalArticle

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title = "Omission of chemotherapy for low-grade, luminal A N1 breast cancer: Patterns of care and clinical outcomes",
abstract = "Purpose: Multiple ongoing randomized studies are assessing the impact of omission of chemotherapy (CT) in low-risk node-positive Luminal A breast. The goal of this investigation was to evaluate trends and practice patterns of adjuvant CT use in Luminal A pT1-3N1 breast cancer, along with determining the clinical benefit from adjuvant CT in this patient population. Methods: The National Cancer Data Base was queried (2004–2014) for women with pT1-3N1 luminal A invasive ductal carcinoma receiving adjuvant hormonal therapy (HT). Multivariable logistic regression ascertained factors associated with adjuvant CT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with CT/HT vs. HT alone, while sub-stratifying patients by age. Results: Of 8548 total patients, 5182 (61{\%}) received CT/HT, while 3366 (39{\%}) received HT alone. A steady rise in omission of adjuvant CT was observed, from 14{\%} (2004–2005) to 41{\%} (2012–2014). A decision not to use CT was more likely in more recent time periods, in older patients, at academic centers, following lumpectomy, and with lower T classification (p < 0.05 for all). CT was associated with higher OS in all patients (p < 0.001) and women ≤50 years old (p = 0.030), but not for ages 51–60 (p = 0.116), 61–70 (p = 0.222), or >70 (p = 0.239). Conclusions: Using CT for Luminal A N1 breast cancer is decreasing over time, primarily in older patients and at academic centers. Although CT is still associated with an OS advantage in all patients, subgroup analysis demonstrated no OS benefit in women >50 years of age. These results have implications on the ongoing randomized trials.",
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T1 - Omission of chemotherapy for low-grade, luminal A N1 breast cancer

T2 - Patterns of care and clinical outcomes

AU - Haque, Waqar

AU - Verma, Vivek

AU - Hatch, Sandra

AU - Klimberg, Vicki

AU - Butler, E. Brian

AU - Teh, Bin S.

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N2 - Purpose: Multiple ongoing randomized studies are assessing the impact of omission of chemotherapy (CT) in low-risk node-positive Luminal A breast. The goal of this investigation was to evaluate trends and practice patterns of adjuvant CT use in Luminal A pT1-3N1 breast cancer, along with determining the clinical benefit from adjuvant CT in this patient population. Methods: The National Cancer Data Base was queried (2004–2014) for women with pT1-3N1 luminal A invasive ductal carcinoma receiving adjuvant hormonal therapy (HT). Multivariable logistic regression ascertained factors associated with adjuvant CT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with CT/HT vs. HT alone, while sub-stratifying patients by age. Results: Of 8548 total patients, 5182 (61%) received CT/HT, while 3366 (39%) received HT alone. A steady rise in omission of adjuvant CT was observed, from 14% (2004–2005) to 41% (2012–2014). A decision not to use CT was more likely in more recent time periods, in older patients, at academic centers, following lumpectomy, and with lower T classification (p < 0.05 for all). CT was associated with higher OS in all patients (p < 0.001) and women ≤50 years old (p = 0.030), but not for ages 51–60 (p = 0.116), 61–70 (p = 0.222), or >70 (p = 0.239). Conclusions: Using CT for Luminal A N1 breast cancer is decreasing over time, primarily in older patients and at academic centers. Although CT is still associated with an OS advantage in all patients, subgroup analysis demonstrated no OS benefit in women >50 years of age. These results have implications on the ongoing randomized trials.

AB - Purpose: Multiple ongoing randomized studies are assessing the impact of omission of chemotherapy (CT) in low-risk node-positive Luminal A breast. The goal of this investigation was to evaluate trends and practice patterns of adjuvant CT use in Luminal A pT1-3N1 breast cancer, along with determining the clinical benefit from adjuvant CT in this patient population. Methods: The National Cancer Data Base was queried (2004–2014) for women with pT1-3N1 luminal A invasive ductal carcinoma receiving adjuvant hormonal therapy (HT). Multivariable logistic regression ascertained factors associated with adjuvant CT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with CT/HT vs. HT alone, while sub-stratifying patients by age. Results: Of 8548 total patients, 5182 (61%) received CT/HT, while 3366 (39%) received HT alone. A steady rise in omission of adjuvant CT was observed, from 14% (2004–2005) to 41% (2012–2014). A decision not to use CT was more likely in more recent time periods, in older patients, at academic centers, following lumpectomy, and with lower T classification (p < 0.05 for all). CT was associated with higher OS in all patients (p < 0.001) and women ≤50 years old (p = 0.030), but not for ages 51–60 (p = 0.116), 61–70 (p = 0.222), or >70 (p = 0.239). Conclusions: Using CT for Luminal A N1 breast cancer is decreasing over time, primarily in older patients and at academic centers. Although CT is still associated with an OS advantage in all patients, subgroup analysis demonstrated no OS benefit in women >50 years of age. These results have implications on the ongoing randomized trials.

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KW - Luminal A

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KW - Mastectomy

KW - Radiation therapy

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