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Can some patients avoid adjuvant chemotherapy for early-stage breast cancer?

Nature Reviews Clinical Oncology volume 8, pages 272–279 (2011)Cite this article

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Abstract

Adjuvant chemotherapy reduces the risk of relapse and mortality for women with early-stage breast cancer. However, many women diagnosed with early-stage breast cancer experience the toxic effects associated with adjuvant chemotherapy without any meaningful benefit. There are a variety of clinicopathological factors—including hormone receptor expression, histology, and proliferation markers such as Ki-67—that can be used to try to identify patients who can safely avoid adjuvant chemotherapy. In addition, novel molecular tools, including the intrinsic molecular subtypes, prognostic multigene assays, and levels of urokinase-type plasminogen activator, provide further prognostic and predictive information to the standard clinicopathological factors thereby improving the accuracy of risk-of-relapse estimation and of the likelihood of response to cytotoxic chemotherapy.

Key Points

  • Adjuvant chemotherapy reduces the risk of disease recurrence and mortality for women diagnosed with early-stage breast cancer

  • Many women with early-stage breast cancer are overtreated with adjuvant chemotherapy

  • High estrogen receptor immunostaining, absence of HER2 overexpression. and low Ki67, as well as classic lobular histology may identify patients who obtain minimal benefit from adjuvant chemotherapy

  • Prognostic multigene-expression signatures and levels of urokinase-type plasminogen activator may further refine estimates of chemotherapy benefit for indeterminate clinicopathological risk patients

  • Treatment recommendations regarding adjuvant chemotherapy should be individualized to account for patient preferences and the degree of uncertainty regarding estimation of risk and chemotherapy sensitivity

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Figure 1: Difference in 5-year DFS rates between ER-positive and ER-negative patients receiving adjuvant chemotherapy in three CALGB trials.17
Figure 2: The chemosensitivity of a breast tumor depends on many factors.

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Authors and Affiliations

  1. Division of Medical Oncology and Drug Development Program, Princess Margaret Hospital, 610 University Avenue, Toronto, M5G 2M9, ON, Canada

    Philippe L. Bedard

  2. Champalimaud Cancer Center, Praça Duque de Saldanha 1, Edifício Atrium Saldanha 9 andar E, 1050–094, Lisbon, Portugal

    Fatima Cardoso

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Both authors contributed to researching the data for the article, discussion of the content, writing the Review, and to editing and revising the article.

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Correspondence to Philippe L. Bedard.

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Bedard, P., Cardoso, F. Can some patients avoid adjuvant chemotherapy for early-stage breast cancer?. Nat Rev Clin Oncol 8, 272–279 (2011). https://doi.org/10.1038/nrclinonc.2011.19

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