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Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG).

Cold S, Düring M, Ewertz M, Knoop A, Møller S - Br. J. Cancer (2005)

Bottom Line: The purpose of this study was to examine the effect on survival of delaying the start of adjuvant chemotherapy for early breast cancer for up to 3 months after surgery.No significant interactions were found for subgroups of patients with a poorer prognosis (many involved lymph nodes, high-grade malignancies or hormone receptor negative disease).In conclusion, we have found no evidence for a survival benefit due to early initiation of adjuvant chemotherapy within the first 2-3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Oncology Department R, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark. soeren.cold@ouh.fyns-amt.dk

ABSTRACT
The purpose of this study was to examine the effect on survival of delaying the start of adjuvant chemotherapy for early breast cancer for up to 3 months after surgery. In the nation-wide clinical trials of the Danish Breast Cancer Cooperative Group, 7501 breast cancer patients received chemotherapy within 3 months of surgery between 1977 and 1999: 352 with classical cyclofosfamide, metotrexate and 5-fluorouracil (CMF); 6065 with CMF i.v. and 1084 with cyclofosfamide, epirubicin and 5-fluorouracil. For the analysis, the time between surgery and the start of chemotherapy was divided into four strata (1-3, 4, 5 and 6-13 weeks). The results show that within the three groups of chemotherapy, there was an even distribution of known prognostic factors across the four strata of initiation of chemotherapy. There was no pattern indicating a benefit from early start of chemotherapy. No significant interactions were found for subgroups of patients with a poorer prognosis (many involved lymph nodes, high-grade malignancies or hormone receptor negative disease). In conclusion, we have found no evidence for a survival benefit due to early initiation of adjuvant chemotherapy within the first 2-3 months after surgery.

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Related in: MedlinePlus

Overall survival among 1084 Danish patients with early breast cancer treated with CEF according to interval from definitive surgery to start of adjuvant chemotherapy.
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fig4: Overall survival among 1084 Danish patients with early breast cancer treated with CEF according to interval from definitive surgery to start of adjuvant chemotherapy.

Mentions: Kaplan–Meier plots of OS are shown in Figures 2, 3 and 4 for classical CMF, CMF i.v., and CEF, respectively. No particular or consistent patterns were observed according to when after surgery the adjuvant chemotherapy started, the P-values ranging from 0.2 to 0.7. This lack of an association between start of chemotherapy and OS was confirmed in multivariate analyses taking known prognostic factors into account. Table 4 indicates a nonsignificantly increased hazard ratio for delaying start of chemotherapy for more than 4 weeks, but this estimate was based on only 352 patients receiving classical CMF. Among the 6065 patients receiving CMF i.v. (Table 5) and the 1084 patients receiving CEF (Table 6) the hazard ratios were close to unity and the associations not significant. Tests were performed for interactions between the prognostic factors shown in Tables 4, 5 and 6 and strata of initiation of chemotherapy and these did not reveal any significant interactions (data not shown).


Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG).

Cold S, Düring M, Ewertz M, Knoop A, Møller S - Br. J. Cancer (2005)

Overall survival among 1084 Danish patients with early breast cancer treated with CEF according to interval from definitive surgery to start of adjuvant chemotherapy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361615&req=5

fig4: Overall survival among 1084 Danish patients with early breast cancer treated with CEF according to interval from definitive surgery to start of adjuvant chemotherapy.
Mentions: Kaplan–Meier plots of OS are shown in Figures 2, 3 and 4 for classical CMF, CMF i.v., and CEF, respectively. No particular or consistent patterns were observed according to when after surgery the adjuvant chemotherapy started, the P-values ranging from 0.2 to 0.7. This lack of an association between start of chemotherapy and OS was confirmed in multivariate analyses taking known prognostic factors into account. Table 4 indicates a nonsignificantly increased hazard ratio for delaying start of chemotherapy for more than 4 weeks, but this estimate was based on only 352 patients receiving classical CMF. Among the 6065 patients receiving CMF i.v. (Table 5) and the 1084 patients receiving CEF (Table 6) the hazard ratios were close to unity and the associations not significant. Tests were performed for interactions between the prognostic factors shown in Tables 4, 5 and 6 and strata of initiation of chemotherapy and these did not reveal any significant interactions (data not shown).

Bottom Line: The purpose of this study was to examine the effect on survival of delaying the start of adjuvant chemotherapy for early breast cancer for up to 3 months after surgery.No significant interactions were found for subgroups of patients with a poorer prognosis (many involved lymph nodes, high-grade malignancies or hormone receptor negative disease).In conclusion, we have found no evidence for a survival benefit due to early initiation of adjuvant chemotherapy within the first 2-3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Oncology Department R, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark. soeren.cold@ouh.fyns-amt.dk

ABSTRACT
The purpose of this study was to examine the effect on survival of delaying the start of adjuvant chemotherapy for early breast cancer for up to 3 months after surgery. In the nation-wide clinical trials of the Danish Breast Cancer Cooperative Group, 7501 breast cancer patients received chemotherapy within 3 months of surgery between 1977 and 1999: 352 with classical cyclofosfamide, metotrexate and 5-fluorouracil (CMF); 6065 with CMF i.v. and 1084 with cyclofosfamide, epirubicin and 5-fluorouracil. For the analysis, the time between surgery and the start of chemotherapy was divided into four strata (1-3, 4, 5 and 6-13 weeks). The results show that within the three groups of chemotherapy, there was an even distribution of known prognostic factors across the four strata of initiation of chemotherapy. There was no pattern indicating a benefit from early start of chemotherapy. No significant interactions were found for subgroups of patients with a poorer prognosis (many involved lymph nodes, high-grade malignancies or hormone receptor negative disease). In conclusion, we have found no evidence for a survival benefit due to early initiation of adjuvant chemotherapy within the first 2-3 months after surgery.

Show MeSH
Related in: MedlinePlus