Dana-Farber Cancer Institute, Boston, MA
Ines Maria Vaz Duarte Luis , Melissa E Hughes , Angel Cronin , Hope S. Rugo , Stephen B. Edge , Beverly Moy , Richard L. Theriault , Eric P. Winer , Nancy U. Lin
Background: We examined time trends of CT used and associations with pts characteristics in Stage I BC. Methods: Prospective cohort studyincluding pts with Stage I BC treated at a National Comprehensive Cancer Network center from 2000-09. We examined the proportion of pts receiving intensive vs. non-intensive CT over time.We defined an intensive regimen as: a combination of anthracyclines and taxanes (e.g. ACT ± H) or a combination of carboplatin and docetaxel (e.g. TCH), and non-intensive as: anthracycline-based (e.g. AC), taxane-based (e.g. TC) or similar. We evaluated factors associated with type of CT using multivariable logistic regression. Analyses were stratified by HER2 receptor status. Results: Of 8,907 pts, 33% received adjuvant CT. There was a dramatic increase of intensive CT: among HER2+ pts from 31% in 2000-05 to 63% in 2008-09 (including an increase in the use of TCH) and among HER2- from 15% in 2000-05 to 41% in 2008-09. Among non-intensive regimens there was an increase in the use of regimens such as TC with a parallel decrease in the use of regimens such as AC, in both HER2+ and HER2- groups. Characteristics which factored into CT decisions differed by tumor subtype, with significant center variations. Conclusions: Over time, there was an increase in use of intensive regimens among Stage I BC. CT use differed by HER2 status with striking center and temporal variations.
HER2+ |
HER2- |
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CT type | ||||||||
Year | N | % | % TCH* | AC-TH* | N | % | % TC# | AC# |
Intensive | Intensive | |||||||
2000-05 | 357 | 31 | 5 | 95 | 1,311 | 15 | 0.3 | 99.7 |
2006-07 | 193 | 65 | 27 | 73 | 463 | 33 | 21 | 79 |
2008-09 | 172 | 63 | 56 | 44 | 427 | 41 | 66 | 34 |
Associations with CT type (diagnosis 2006-2009) | ||||||||
Intensive vs. nonintensive |
TCH vs. ACTH |
Intensive vs. nonintensive |
TC vs. AC |
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OR | P | OR | P | OR | P | OR | P | |
Age (decade) | 1.0 | 0.11 | 1.0 | 0.20 | 0.95 | <0.01 | 1.03 | 0.01 |
HR + (v -) | 0.7 | 0.25 | 1.0 | 0.97 | 0.3 | <0.01 | 0.8 | 0.48 |
Tumor size (cm) | 2.0 | 0.04 | 0.3 | <0.01 | 2.6 | <0.01 | 1.1 | 0.71 |
Race/ethnicity (other vs. white) |
0.5 | 0.11 | 1.3 | 0.59 | 1.3 | 0.21 | 1.6 | 0.22 |
Comorbidity score (1+ v 0) |
0.7 | 0.26 | 1.9 | 0.12 | 1.1 | 0.71 | 1.3 | 0.52 |
Year | 1.4 | 0.02 | 1.8 | <0.01 | 1.3 | <0.01 | 3.5 | <0.01 |
High grade | 1.2 | 0.57 | 2.9 | <0.01 | 1.9 | <0.01 | 0.8 | 0.35 |
Lymphovascular invasion |
1.5 | 0.37 | 0.9 | 0.85 | 2.1 | <0.01 | 1.0 | 0.95 |
Center | <0.01 | 0.02 | <0.01 | <0.01 |
Among pts receiving *TCH/ACTH (represents 53% of pts with HER2+disease ). # TC/AC ( 68% of pts with HER2- disease).
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