Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study

Matteo Clavarezza,Stefania Gori,Lucia Del Mastro,Enrico Aitini,Francesco Giotta,Andrea Casadei Gardini,Francesco Carrozza,Marco Venturini,Evaristo Maiello,Ferdinando Riccardi,Giorgio Mustacchi,Paolo Marchetti,Andrea De Matteis,Domenico Amoroso,Vincenzo Adamo,Davide Dondi

doi:10.1186/1471-2407-12-216

Abstract

BackgroundInternational treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters.MethodsAn observational study (NEMESI) was conducted in 63 Italian oncology centres in patients with early breast cancer. Age, performance status, concomitant disease, menopausal status, histology, tumor dimension (pT), axillary lymph node status (pN), grading (G), estrogen and progesterone receptor (ER and PgR), proliferative index (ki67 or MIB-1), human epidermal growth factor receptor 2 (HER2) and type of adjuvant treatment were recorded. The primary objective of the study was to define parameters influencing the decision to prescribe adjuvant chemotherapy and the type of chemotherapy.ResultsData for 1894 patients were available. 69.0% postmenopausal, 67.0% pT1, 22.3% pTmic/pT1a/pT1b, 61.0% pN0, 48.7% luminal A, 18.1% luminal B, 16.1% HER2 positive, 8.7% triple negative, 8.4% unknown. 57.8% received adjuvant chemotherapy: 38.1% of luminal A, 67.3% luminal B, 88.2% HER2-positive, 97.6% triple negative. Regimens administered: 9.1% CMF-like, 48.8% anthracyclines, 38.4% anthracyclines plus taxanes, 3.7% taxanes alone. Increasing pT/pN and, marginally, HER2-positive were associated with the prescription of anthracyclines plus taxanes. Suboptimal schedules (CMF-like or AC/EC or FEC-75) were prescribed in 37.3% receiving chemotherapy, even in HER2-positive and triple negative disease (36.5% and 34.0%, respectively).ConclusionsThis study showed an overprescription of adjuvant chemotherapy for early breast cancer, particularly referred to luminal A. pT, pN and, marginally, HER2 were the principal determinants for the choice of chemotherapy type. Suboptimal chemotherapy regimens were adopted in at least one third of HER2-positve and triple negative.

Highlights

International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters
Centres were selected from the 386 censed centres reported in the White Book of the Italian Association of Medical Oncology (AIOM 2006) in order to covering the whole spectrum of treatment of breastcancer patients [15]
Demographic and breast cancer biological characteristics Data were collected from a total of 1894 patients in the 63 participating Italian oncology centres

Summary

Introduction

International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters. In Italy breast cancer incidence vary according to geographic location It is 115 cases per 100,000 women (45000 new cases each year), consisting of 29% of all new diagnosis of malignancies, with significant differences between North, Centre and South Italy: 123, 103 and 87 new cases are diagnosed each year per 100,000 women, respectively [9]. This difference is due to the different extension of mammographic screening and different risk factors for breast cancer, above all the different life-styles, with North Italy with a life-style more similar to North Europe and United States compared to South Italy

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