Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 32, Issue 8, Pages 735-744Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1200/JCO.2013.49.7693
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Funding
- National Cancer Institute of the National Institutes of Health [1K23CA121994-01]
- Komen for the Cure Catalyst Award [KG090341]
- American Cancer Society [121329-RSG-11-187-01-TBG]
- Cancer Center Support Grant from the Department of Health and Human Services, National Institutes of Health, National Cancer Institute [2P30 CA016672 (PP-RP6)]
- Nelly B. Connally Breast Cancer Research Fund
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Purpose For patients with breast cancer (BC), the optimal time to initiation of adjuvant chemotherapy (TTC) after definitive surgery is unknown. We evaluated the association between TTC and survival according to breast cancer subtype and stage at diagnosis. Patients and Methods Women diagnosed with BC stages I to III between 1997 and 2011 who received adjuvant chemotherapy at our institution were included. Patients were categorized into three groups according to TTC: 30, 31 to 60, and 61 days. Survival outcomes were estimated and compared according to TTC and by BC subtype. Results Among the 6,827 patients included, the 5-year overall survival (OS), relapse-free survival (RFS), and distant RFS (DRFS) estimates were similar for the different TTC categories. Initiation of chemotherapy 61 days after surgery was associated with adverse outcomes among patients with stage II (DRFS: hazard ratio [HR], 1.20; 95% CI, 1.02 to 1.43) and stage III (OS: HR, 1.76; 95% CI, 1.26 to 2.46; RFS: HR, 1.34; 95% CI, 1.01 to 1.76; and DRFS: HR, 1.36; 95% CI, 1.02 to 1.80) BC. Patients with triple-negative BC (TNBC) tumors and those with human epidermal growth factor receptor 2 (HER2) -positive tumors treated with trastuzumab who started chemotherapy 61 days after surgery had worse survival (HR, 1.54; 95% CI, 1.09 to 2.18 and HR, 3.09; 95% CI, 1.49 to 6.39, respectively) compared with those who initiated treatment in the first 30 days after surgery. Conclusion TTC influenced survival outcomes in the overall study cohort. This finding was particularly meaningful for patients with stage III BC, TNBC, and trastuzumab-treated HER2-positive tumors who experienced worse outcomes when chemotherapy was delayed. Our findings suggest that early initiation of chemotherapy should be granted for patients in these high-risk groups.
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