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Twenty-Year Benefit...
Twenty-Year Benefit From Adjuvant Goserelin and Tamoxifen in Premenopausal Patients With Breast Cancer in a Controlled Randomized Clinical Trial
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- Johansson, Annelie (författare)
- Karolinska Institutet
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- Dar, Huma (författare)
- Karolinska Institutet
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- Veer, Laura J. van t (författare)
- Univ Calif San Francisco, CA USA
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- Tobin, Nicholas P. (författare)
- Karolinska Institutet
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- Perez-Tenorio, Gizeh (författare)
- Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US
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- Nordenskjöld, Anna (författare)
- Gothenburg Univ, Sweden
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- Johansson, Ulla (författare)
- Karolinska Univ Hosp, Sweden
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- Hartman, Johan (författare)
- Karolinska Institutet
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- Skoog, Lambert (författare)
- Karolinska Institutet
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- Yau, Christina (författare)
- Buck Inst Res Aging, CA USA; Univ Calif San Francisco, CA USA
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- Benz, Christopher C. (författare)
- Buck Inst Res Aging, CA USA; Univ Calif San Francisco, CA USA
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- Esserman, Laura J. (författare)
- Univ Calif San Francisco, CA USA
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- Stål, Olle (författare)
- Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US
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- Nordenskjöld, Bo (författare)
- Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US
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- Fornander, Tommy (författare)
- Karolinska Inst, Sweden
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- Lindstrom, Linda S. (författare)
- Karolinska Inst, Sweden
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(creator_code:org_t)
- Lippincott, Williams & Wilkins, 2022
- 2022
- Engelska.
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Ingår i: Journal of Clinical Oncology. - : Lippincott, Williams & Wilkins. - 0732-183X .- 1527-7755. ; 40:35, s. 4071-4082
- Relaterad länk:
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https://liu.diva-por... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- PURPOSETo assess the long-term (20-year) endocrine therapy benefit in premenopausal patients with breast cancer.METHODSSecondary analysis of the Stockholm trial (STO-5, 1990-1997) randomly assigning 924 premenopausal patients to 2 years of goserelin (3.6 mg subcutaneously once every 28 days), tamoxifen (40 mg orally once daily), combined goserelin and tamoxifen, or no adjuvant endocrine therapy (control) is performed. Random assignment was stratified by lymph node status; lymph node-positive patients (n = 459) were allocated to standard chemotherapy (cyclophosphamide, methotrexate, and fluorouracil). Primary tumor immunohistochemistry (n = 731) and gene expression profiling (n = 586) were conducted in 2020. The 70-gene signature identified genomic low-risk and high-risk patients. Kaplan-Meier analysis, multivariable Cox proportional hazard regression, and multivariable time-varying flexible parametric modeling assessed the long-term distant recurrence-free interval (DRFI). Swedish high-quality registries allowed a complete follow-up of 20 years.RESULTSIn estrogen receptor-positive patients (n = 584, median age 47 years), goserelin, tamoxifen, and the combination significantly improved long-term distant recurrence-free interval compared with control (multivariable hazard ratio [HR], 0.49; 95% CI, 0.32 to 0.75, HR, 0.57; 95% CI, 0.38 to 0.87, and HR, 0.63; 95% CI, 0.42 to 0.94, respectively). Significant goserelin-tamoxifen interaction was observed (P = .016). Genomic low-risk patients (n = 305) significantly benefitted from tamoxifen (HR, 0.24; 95% CI, 0.10 to 0.60), and genomic high-risk patients (n = 158) from goserelin (HR, 0.24; 95% CI, 0.10 to 0.54). Increased risk from the addition of tamoxifen to goserelin was seen in genomic high-risk patients (HR, 3.36; 95% CI, 1.39 to 8.07). Moreover, long-lasting 20-year tamoxifen benefit was seen in genomic low-risk patients, whereas genomic high-risk patients had early goserelin benefit.CONCLUSIONThis study shows 20-year benefit from 2 years of adjuvant endocrine therapy in estrogen receptor-positive premenopausal patients and suggests differential treatment benefit on the basis of tumor genomic characteristics. Combined goserelin and tamoxifen therapy showed no benefit over single treatment. Long-term follow-up to assess treatment benefit is critical.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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- ref (ämneskategori)
- art (ämneskategori)
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Johansson, Annel ...
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Dar, Huma
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Veer, Laura J. v ...
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Tobin, Nicholas ...
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Perez-Tenorio, G ...
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Nordenskjöld, An ...
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Johansson, Ulla
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Hartman, Johan
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Skoog, Lambert
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Yau, Christina
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Benz, Christophe ...
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Esserman, Laura ...
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Stål, Olle
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Nordenskjöld, Bo
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Fornander, Tommy
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Lindstrom, Linda ...
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- MEDICIN OCH HÄLSOVETENSKAP
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Linköpings universitet
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Karolinska Institutet