World J Breast Cancer Res | Volume 2, Issue 1 | Research Article | Open Access
Arianna Vallario1, Tommaso Susini1*, Ketty Tavella2, Alessandro Villanucci2 and Jacopo Nori3
1Department of Health Sciences, University of Florence, Italy
2Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Italy
3Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Italy
*Correspondance to: Tommaso Susini
Fulltext PDFBackground: Over the last decades, the standard adjuvant chemotherapy for breast cancer changed various times, following the results of randomized controlled trials. The aim of the present study was to review the experience of our Unit, comparing three different regimens for breast cancer, used in subsequent years: CMF, protocols containing anthracyclines, and then taxanes, either in monotherapy or in combination with anthracyclines and/or trastuzumab.
Methods: We retrospectively analysed the results of 230 breast cancer patients operated on in our Unit between the year 2000 and 2017 and treated with adjuvant chemotherapy. The patients had mean follow-up of 60 months (Range 12 months to 192 months). Disease-free survival and toxicity were evaluated according to the adjuvant chemotherapy regimen used.
Results: The chemotherapy regimen used significantly influenced disease-free survival (p=0.02). The impact on relapse appeared comparable choosing either CMF scheme or anthracyclines. Whereas, taxane-containing regimens proved to be significantly protective against relapse (HR=0.33), by univariate Cox analysis (p=0.04). By multivariate analysis, the influence of adjuvant chemotherapy was even stronger (p=0.01) and taxane reduced dramatically the relapse risk (HR=0.26). The adjuvant chemotherapy regimen was a significant and independent prognostic factor for diseasefree interval. The superiority of taxane-based therapy, compared to anthracyclines and CMF, was evident also in triple-negative tumours, as 100% of patients were disease-free after 96 months of follow up. Concerning toxicity, taxane was the best tolerable regimen and significantly reduced hematological, gastrointestinal and cutaneous toxicity. In a separate analysis for HER2-positive tumours, 90% of the patients treated with trastuzumab were disease-free at 100 months follow up, in comparison with only 65% of HER2-positive women not undergoing this treatment. Conclusions: Our study showed that taxane-containing regimens, either in combination with anthracyclines or in monotherapy, were the most effective and tolerable adjuvant chemotherapy for breast cancer. These results confirm the current literature knowledge about the effectiveness of taxanes as adjuvant treatment for breast cancer. In addition, our study also confirmed the value of trastuzumab as adjuvant therapy in HER2-positive women on disease-free survival.
Breast cancer; Adjuvant chemotherapy; Taxanes; Anthracyclines; CMF; Trastuzumab; Toxicity
Vallario A, Susini T, Tavella K, Villanucci A, Nori J. Evolution of Adjuvant Chemotherapy for Breast Cancer: Review of Our Experience with Three Chemotherapy Regimens and Trastuzumab, Between 2000 and 2017. World J Breast Cancer Res. 2019;2(1):1009.