Annals of Oncology Advance Access originally published online on September 29, 2008
Annals of Oncology 2009 20(1):193-194; doi:10.1093/annonc/mdn633
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
letters to the editor |
Reply to Adjuvant chemotherapy and prognosis in patients with breast cancer
We thank Dr Kilickap et al. for their comments on our article in which prior adjuvant therapy was found to be associated with a poorer outcome in multivariate analysis from the time of metastatic occurrence [1]. We do not share their statement that this result is a consequence of an insufficient initial treatment of breast cancer patients followed in our cancer center since we cannot judge of treatment modalities in the past with current guidelines. Our treatment decisions were established during a multidisciplinary tumor broad according to international standards of care of the corresponding periods. T1 status and lymph node negative patients represent 48.3% and 37% of the cohort, respectively, which explains in part why only 40% (312 of 794) of all hormonal receptor positive patients received hormonotherapy. In previous studies, similar proportions were reported [2, 3]. Besides, as stated in our article, the frequency of hormonotherapy increased along the different periods of treatment (Figure 1), consistent with the arrival of tamoxifen in early breast cancer treatment in the 1980s and the gradual extension of adjuvant hormonotherapy indications.
|
The fact that women with metastatic breast cancer who received adjuvant chemotherapy seem to have a poorer survival rate than chemotherapy-naive patients has already been enlightened in other studies [4, 5]. In a retrospective Spanish study of 1436 stages I–IIIa breast cancer patients, metastatic recurrence occurred in 297 patients and the use of anthracyclines previously as adjuvant therapy worsened the prognosis with a median survival of 20 months without anthracyclines versus 17 months with anthracyclines (P = 0.0008) [6]. Recently, the analysis of the subset of colorectal patients who experienced tumor recurrence after initial therapy for stage II or III colon cancers (FU-based adjuvant chemotherapy versus surgery only) clearly indicated that patients initially treated with adjuvant chemotherapy had a shorter survival following recurrence (median 14.2 versus 11.5 months, P = 0.0005) [7]. Such results are not surprising since patients who received adjuvant chemotherapy represent a population with more aggressive tumors than those to whom adjuvant chemotherapy was not proposed. Furthermore, the poorer outcome after recurrence in this subset of patients may be due to the emergence of cell clones initially resistant to drugs with less chemosensitivity at the onset of a metastatic stage [7, 8]. Another explanation could be found in a lower dose intensity of the following chemotherapy regimens in patients who previously received adjuvant chemotherapy secondary to a poorer performance status, a higher depression rate or persistent toxic effects from the adjuvant regimen (anthracyclines and cardiotoxicity). In the future, investigating response rates of different types of drugs in this subgroup of patients may be of high interest in selecting the first line chemotherapy regimen.
Centre Antoine Lacassagne, Nice, France
* (E-mail: emmanuel.chamorey{at}nice.fnclcc.fr)
References
1. Largillier R, Ferrero JM, Doyen J, et al. Prognostic factors in 1038 women with metastatic breast cancer. Ann Oncol (2008) 19:2012–2019.
2. Clark GM, Sledge GW Jr, Osborne CK, et al. Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol (1987) 5:55–61.[Abstract]
3. Ryberg M, Nielsen D, Osterlind K, et al. Prognostic factors and long-term survival in 585 patients with metastatic breast cancer treated with epirubicin-based chemotherapy. Ann Oncol (2001) 12:81–87.
4. Houston SJ, Richards MA, Bentley AE, et al. The influence of adjuvant chemotherapy on outcome after relapse for patients with breast cancer. Eur J Cancer (1993) 29A:1513–1518.[CrossRef]
5. Bonneterre J, Mercier M. Response to chemotherapy after relapse in patients with or without previous adjuvant chemotherapy for breast cancer. The French Epirubicin Study Group. Cancer Treat Rev (1993) 19(Suppl B):21–30.
6. Alba E, Ribelles N, Sevilla I, et al. Adjuvant anthracycline therapy as a prognostic factor in metastatic breast cancer. Breast Cancer Res Treat (2001) 66:33–39.[CrossRef][Web of Science][Medline]
7. O'Connell MJ, Campbell ME, Goldberg RM, et al. Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. J Clin Oncol (2008) 26:2336–2341.
8. Li X, Lewis MT, Huang J, et al. Intrinsic resistance of tumorigenic breast cancer cells to chemotherapy. J Natl Cancer Inst (2008) 100:672–679.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||