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Tamoxifen therapy b...
Tamoxifen therapy benefit for patients with 70-gene signature high and low risk
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van t Veer, Laura J. (författare)
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Yau, Christina (författare)
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Yu, Nancy Y. (författare)
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Benz, Christopher C. (författare)
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Nordenskjöld, Bo, 1940- (författare)
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Fornander, Tommy (författare)
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Stål, Olle (författare)
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Esserman, Laura J. (författare)
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Sofie Lindstrom, Linda (författare)
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- SPRINGER, 2017
- 2017
- Engelska.
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Ingår i: Breast Cancer Research and Treatment. - 0167-6806. ; 166:2, 593-601
Abstract
Ämnesord
Stäng
- Breast cancer molecular prognostic tools that predict recurrence risk have mainly been established on endocrine-treated patients and thus are not optimal for the evaluation of benefit from endocrine therapy. The Stockholm tamoxifen (STO-3) trial which randomized postmenopausal node-negative patients to 2-year tamoxifen (followed by an optional randomization for an additional 3-year tamoxifen vs nil), versus no adjuvant treatment, provides a unique opportunity to evaluate long-term 20-year benefit of endocrine therapy within prognostic risk classes of the 70-gene prognosis signature that was developed on adjuvantly untreated patients. We assessed by Kaplan-Meier analysis 20-year breast cancer-specific survival (BCSS) and 10-year distant metastasis-free survival (DMFS) for 538 estrogen receptor (ER)-positive, STO-3 trial patients with retrospectively ascertained 70-gene prognosis classification. Multivariable analysis of long-term (20 years) BCSS by STO-3 trial arm in the 70-gene high-risk and low-risk subgroups was performed using Cox proportional hazard modeling adjusting for classical patient and tumor characteristics. Tamoxifen-treated, 70-gene low- and high-risk patients had 20-year BCSS of 90 and 83%, as compared to 80 and 65% for untreated patients, respectively (log-rank p amp;lt; 0.0001). Notably, there is equivalent tamoxifen benefit in both high (HR 0.42 (0.21-0.86), p = 0.018) and low (HR 0.46 (0.25-0.85), p = 0.013) 70-gene risk categories even after adjusting for clinico-pathological factors for BCSS. Limited tamoxifen exposure as given in the STO-3 trial provides persistent benefit for 10-15 years after diagnosis in a time-varying analysis. 10-year DMFS was 93 and 85% for low- and high-risk tamoxifen-treated, versus 83 and 70% for low- and high-risk untreated patients, respectively (log-rank p amp;lt; 0.0001). Patients with ER-positive breast cancer, regardless of high or low 70-gene risk classification, receive significant survival benefit lasting over 10 years from adjuvant tamoxifen therapy, even when given for a relatively short duration.
Ämnesord
- Medical and Health Sciences (ssif)
- Clinical Medicine (ssif)
- Cancer and Oncology (ssif)
- Medicin och hälsovetenskap (ssif)
- Klinisk medicin (ssif)
- Cancer och onkologi (ssif)
Nyckelord
- 70-gene signature; Tamoxifen benefit; Endocrine therapy; Breast cancer; Long-term survival
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