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      Adjuvant chemotherapy of pT1a and pT1b breast carcinoma: results from the NEMESI study

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          Abstract

          Background

          The prognosis of pT1a-pT1b breast cancer (BC) used to be considered very good, with a 10-y RFS of 90%. However, some retrospective studies reported a 10-y RFS of 81%–86% and suggested benefit from adjuvant systemic therapy.

          Methods

          To evaluate the variables that determined the choice of adjuvant chemotherapy and the type of chemotherapy delivered in pT1a-pT1b BC, we analysed the small tumours enrolled in the NEMESI study.

          Results

          Out of 1,894 patients with pathological stage I-II BC enrolled in NEMESI, 402 (21.2%) were pT1a-pT1b. Adjuvant chemotherapy was delivered in 127/402 (31.59%). Younger age, grading G3, high proliferative index, ER-negative and HER2-positive status were significantly associated with the decision to administer adjuvant chemotherapy. An anthracycline without taxane regimen was administered in 59.1% of patients, anthracycline with taxane in 24.4%, a CMF-like regimen in 14.2% and taxane in 2.4%. Adjuvant chemotherapy was administered in 88.4% triple-negative and 73.46% HER2-positive pT1a-pT1b BC. Adjuvant trastuzumab was delivered in 30/49 HER2-positive BC (61.2%).

          Conclusions

          Adjuvant chemotherapy was delivered in 31.59% T1a-pT1b BC treated at 63 Italian oncological centres from January 2008 to June 2008. The choice to deliver chemotherapy was based on biological prognostic factors. Anthracycline-based chemotherapy was administered in 83.5% patients.

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          Most cited references29

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          Estimates of cancer incidence and mortality in Europe in 2008.

          J Ferlay, D.M. PARKIN, E Steliarova-Foucher (2010)
          Up-to-date statistics on cancer occurrence and outcome are essential for the planning and evaluation of programmes for cancer control. Since the relevant information for 2008 is not generally available as yet, we used statistical models to estimate incidence and mortality data for 25 cancers in 40 European countries (grouped and individually) in 2008. The calculations are based on published data. If not collected, national rates were estimated from national mortality data and incidence and mortality data provided by local cancer registries of the same or neighbouring country. The estimated 2008 rates were applied to the corresponding country population estimates for 2008 to obtain an estimate of the numbers of cancer cases and deaths in Europe in 2008. There were an estimated 3.2 million new cases of cancer and 1.7 million deaths from cancer in 2008. The most common cancers were colorectal cancers (436,000 cases, 13.6% of the total), breast cancer (421,000, 13.1%), lung cancer (391,000, 12.2%) and prostate cancer (382,000, 11.9%). The most common causes of death from cancer were lung cancer (342,000 deaths, 19.9% of the total), colorectal cancer (212,000 deaths, 12.3%), breast cancer (129,000, 7.5%) and stomach cancer (117,000, 6.8%). Copyright 2009 Elsevier Ltd. All rights reserved.
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            Revision of the American Joint Committee on Cancer staging system for breast cancer.

            S Singletary, Craig Allred, Pandora Ashley … (2002)
            To revise the American Joint Committee on Cancer staging system for breast carcinoma. A Breast Task Force submitted recommended changes and additions to the existing staging system that were (1) evidence-based and/or consistent with widespread clinical consensus about appropriate diagnostic and treatment standards and (2) useful for the uniform accrual of outcome information in national databases. Major changes included the following: size-based discrimination between micrometastases and isolated tumor cells; identifiers to indicate usage of innovative technical approaches; classification of lymph node status by number of involved axillary lymph nodes; and new classifications for metastasis to the infraclavicular, internal mammary, and supraclavicular lymph nodes. This revised staging system will be officially adopted for use in tumor registries in January 2003.
            Article 0 comments Cited 207 times – based on 0 reviews     Review now
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              Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005.

              A Goldhirsch, J.H. Glick, R.D. Gelber … (2005)
              The ninth St Gallen (Switzerland) expert consensus meeting in January 2005 made a fundamental change in the algorithm for selection of adjuvant systemic therapy for early breast cancer. Rather than the earlier approach commencing with risk assessment, the Panel affirmed that the first consideration was endocrine responsiveness. Three categories were acknowledged: endocrine responsive, endocrine non-responsive and tumors of uncertain endocrine responsiveness. The three categories were further divided according to menopausal status. Only then did the Panel divide patients into low-, intermediate- and high-risk categories. It agreed that axillary lymph node involvement did not automatically define high risk. Intermediate risk included both node-negative disease (if some features of the primary tumor indicated elevated risk) and patients with one to three involved lymph nodes without additional high-risk features such as HER 2/neu gene overexpression. The Panel recommended that patients be offered chemotherapy for endocrine non-responsive disease; endocrine therapy as the primary therapy for endocrine responsive disease, adding chemotherapy for some intermediate- and all high-risk groups in this category; and both chemotherapy and endocrine therapy for all patients in the uncertain endocrine response category except those in the low-risk group.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Cancer
                Journal ID (iso-abbrev): BMC Cancer
                Title: BMC Cancer
                Publisher: BioMed Central
                ISSN (Electronic): 1471-2407
                Publication date Collection: 2012
                Publication date (Electronic): 30 April 2012
                Volume: 12
                Page: 158
                Affiliations
                [1 ]Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
                [2 ]Oncologia, Ospedale Sacro Cuore-Don Calabria, Negrar, (VR), Italy
                [3 ]Struttura Complessa di Oncologia Falck, Ospedale Niguarda Ca’ Granda, Milan, Italy
                [4 ]UO Oncologia, Azienda Ospedaliera Sant’Anna, Como, Italy
                [5 ]U.O.C. di Oncologia dell’Ospedale Civile Maggiore, Azienda Ospedaliera-Universitaria di Verona, Verona, Italy
                [6 ]Oncologia Medica, Ospedale di Bolzano, Bolzano, Italy
                [7 ]Oncologia, Azienda Ospedaliera di Alessandria, Alessandria, Italy
                [8 ]SC Oncologia, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy
                [9 ]Oncologia Medica, Ospedale Campo di Marte, Lucca, Italy
                [10 ]UO Oncologia Medica, Ospedale S.S. Trinità, Sora (FR), Sassari, Italy
                [11 ]Oncologia Medica, Università degli Studi Messina, Messina, Italy
                [12 ]Medical & Scientific Department, Sanofi-Aventis, Milan, Italy
                [13 ]Division of Medical Oncology, Ospedale S. Maria della Misericordia, Azienda Ospedaliera Perugia, via Dottori 1, Perugia, 06122, Italy
                Article
                Publisher ID: 1471-2407-12-158
                DOI: 10.1186/1471-2407-12-158
                PMC ID: 3404902
                PubMed ID: 22545982
                SO-VID: 296d1faa-7c80-4a97-8265-f38a299d944e
                Copyright © Copyright ©2012 Gori et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http:// http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 July 2011
                Date accepted : 30 April 2012
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: pt1a and pt1b breast cancer,adjuvant hormonal therapy,adjuvant chemotherapy
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: pt1a and pt1b breast cancer, adjuvant hormonal therapy, adjuvant chemotherapy

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