Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer Journal Article
| Authors: | Berry, D. A.; Cirrincione, C.; Henderson, I. C.; Citron, M. L.; Budman, D. R.; Goldstein, L. J.; Martino, S.; Perez, E. A.; Muss, H. B.; Norton, L.; Hudis, C.; Winer, E. P. |
| Article Title: | Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer |
| Abstract: | Context: 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. Objective: To compare differences in benefits from adjuvant chemotherapy achieved by patients with ER-negative vs ER-positive tumors. Design, Setting, and Patients: 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. Main Outcome Measures: Disease-free and overall survival. Results: 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%. Conclusion: 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. ©2006 American Medical Association. All rights reserved. |
| Keywords: | cancer survival; treatment outcome; clinical trial; cancer recurrence; doxorubicin; fluorouracil; paclitaxel; cancer adjuvant therapy; cancer patient; breast cancer; cyclophosphamide; cancer mortality; statistical significance; tamoxifen; multivariate analysis; estrogen receptor; risk reduction |
| Journal Title: | JAMA - Journal of the American Medical Association |
| Volume: | 295 |
| Issue: | 14 |
| ISSN: | 0098-7484 |
| Publisher: | American Medical Association |
| Date Published: | 2006-04-12 |
| Start Page: | 1658 |
| End Page: | 1667 |
| Language: | English |
| DOI: | 10.1001/jama.295.14.1658 |
| PROVIDER: | scopus |
| PMCID: | PMC1459540 |
| PUBMED: | 16609087 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 296" - "Export Date: 4 June 2012" - "CODEN: JAMAA" - "Source: Scopus" |
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