Anastrozole after tamoxifen in early breast cancer patients with chemotherapy-induced ovarian function failure.

Authors

Vivianne Tjan-Heijnen

Vivianne C. Tjan-Heijnen

Maastricht University Medical Centre, Maastricht, Netherlands

Vivianne C. Tjan-Heijnen , Irene Van Hellemond , Ingeborg Vriens , Petronella Peer , Astrid Swinkels , Carolien H. Smorenburg , Maurice Van Der Sangen , Judith R. Kroep , Hiltje de Graaf , Aafke H. Honkoop , Frans Erdkamp , Franchette van den Berkmortel , Maaike De Boer , Wilfred de Roos , Sabine C. Linn , Alexander Imholz , Caroline Seynaeve

Organizations

Maastricht University Medical Centre, Maastricht, Netherlands, Radboud University Medical Center, Nijmegen, Netherlands, Comprehensive Cancer Organization Netherlands, Nijmegen, Netherlands, Medisch Centrum Alkmaar, Alkmaar, Netherlands, Catharina Hospital, Eindhoven, Netherlands, Leiden University Medical Center, Leiden, Netherlands, Medical Center Leeuwarden, Leeuwarden, Netherlands, Isala Clinics, Zwolle, Netherlands, Zuyderland Hospital, Sittard, Netherlands, Zuyderland Hospital, Heerlen, Netherlands, Gelderse Vallei Hospital, Ede, Netherlands, Department of Medical Oncology- Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, Netherlands, Deventer Hospital, Deventer, Netherlands, Erasmus MC Cancer Institute, Department of Medical Oncology and Cancer Genomics, Rotterdam, Netherlands

Research Funding

Pharmaceutical/Biotech Company

Background: The DATA study compared 6 and 3 years of anastrozole therapy in postmenopausal women with hormone-receptor positive early breast cancer previously treated with 2-3 years tamoxifen (oral presentation SABCS 2016 #S01-03). The study included postmenopausal women, allowing those with chemotherapy-induced ovarian function failure (CIOFF). However, these may be at risk of ovarian function recovery (OFR). The current analysis compared the survival of women with CIOFF with definite postmenopausal women and examined the influence of OFR on survival. Methods: We selected patients from the DATA study aged 45-57 years at randomization who had received (neo-)adjuvant chemotherapy. They were classified by menopausal status at randomization (definite postmenopausal before chemotherapy or by ovariectomy, versus CIOFF). The latter were monitored by estradiol measurements for OFR during anastrozole. Endpoints: Disease-free Survival (DFS), Distant Recurrence-free Survival (DRFS), and Overall Survival (OS), corrected for tumor size, nodal status, grade, and hormone-receptor status. We used the landmark method to calculate residual 5-year survival rates. Results: In total, 261 patients were definite postmenopausal and 395 had CIOFF, of whom 39 experienced OFR while 290 did not (66 were excluded from the landmark analysis because follow-up estradiol levels were lacking). When comparing the CIOFF with the definite postmenopausal women, the 5-year survival rates were not significantly different. Within the group with CIOFF, experiencing OFR was associated with a trend for worse outcome (DFS-event HR 1.33 (95% CI 0.61-2.90), P=0.48; DRFS-event HR 2.11 (95% CI 0.89-5.02), P=0.09; and OS-event HR 2.24 (95% CI 0.92-5.45), P=0.07). Patients who experienced OFR in the first year had a residual 5-year rate for DFS of 73.1% compared with 87.4% in those who did not. For DRFS these rates were 76.9% vs. 92.1%, and for OS 80.8% vs. 94.4% respectively. Conclusions: These results suggest that women with CIOFF undergoing anastrozole treatment may be at increased risk of disease recurrence if experiencing OFR despite close monitoring of estradiol levels and adjusting endocrine treatment. Clinical trial information: NCT00301457

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer—Local/Regional/Adjuvant

Track

Breast Cancer

Sub Track

Adjuvant Therapy

Clinical Trial Registration Number

NCT00301457

Citation

J Clin Oncol 35, 2017 (suppl; abstr 523)

DOI

10.1200/JCO.2017.35.15_suppl.523

Abstract #

523

Poster Bd #

123

Abstract Disclosures