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Patterns of recurrence of early breast cancer according to estrogen receptor status: a therapeutic target for a quarter of a century

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Abstract

The current therapeutic strategy in breast cancer is to identify a target, such as estrogen receptor (ER) status, for tailoring treatments. We investigated the patterns of recurrence with respect to ER status for patients treated in two randomized trials with 25 years’ median follow-up. In the ER-negative subpopulations most breast cancer events occurred within the first 5–7 years after randomization, while in the ER-positive subpopulations breast cancer events were spread through 10 years. In the ER-positive subpopulation, 1 year endocrine treatment alone significantly prolonged disease-free survival (DFS) with no additional benefit observed by adding 1 year of chemotherapy. In the small ER-negative subpopulation chemo-endocrine therapy had a significantly better DFS than endocrine alone or no treatment. Despite small numbers of patients, “old-fashioned” treatments, and competing causes of treatment failure, the value of ER status as a target for response to adjuvant treatment is evident through prolonged follow-up.

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Acknowledgments

We thank the patients, physicians, nurses, and data managers who participate in the International Breast Cancer Study Group trials. We thank Rita Hinkle for data management and IBCSG patients and participants who have submitted yearly trial patient data for 30 years: West Swedish Breast Cancer Group; Institute of Oncology, Ljubljana, Slovenia; Swiss Group for Clinical Cancer Research (SAKK); Australian New Zealand Breast Cancer Trials Group (ANZ BCTG); Groote Shuur Hospital, Cape Town, South Africa. Funding (in addition to above) provided by: Ludwig Institute for Cancer Research, Swedish Cancer Society, The Cancer Council Australia, National Health Medical Research Council of Australia, Frontier Science and Technology Research Foundation, US-National Cancer Institute (CA-75362), Cancer Association of South Africa (CANSA), and Foundation of Clinical Cancer Research of Eastern Switzerland (OSKK).

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Authors and Affiliations

  1. Oncology Institute of Southern Switzerland, Ospedale Italiano, Viganello, Lugano, Switzerland

    Olivia Pagani

  2. Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland

    Olivia Pagani, Beat Thürlimann & Martin F. Fey

  3. IBCSG Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA, USA

    Karen N. Price

  4. IBCSG Statistical Center, Dana-Farber Cancer Institute and Frontier Science and Technology Research Foundation, Boston, MA, USA

    Richard D. Gelber

  5. IBCSG Coordinating Center, Bern, Switzerland

    Monica Castiglione-Gertsch

  6. Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden

    Stig B. Holmberg

  7. The Institute of Oncology, Ljubljana, Slovenia

    Jurij Lindtner

  8. Senology Center of Eastern Switzerland, Kantonsspital, St. Gallen, Switzerland

    Beat Thürlimann

  9. Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia

    John Collins

  10. Department of Medical Oncology, Inselspital, Bern, Switzerland

    Martin F. Fey

  11. International Breast Cancer Study Group, Bern, Switzerland

    Alan S. Coates

  12. University of Sydney, Sydney, Australia

    Alan S. Coates

  13. Department of Medicine, European Institute of Oncology, Milan, Italy

    Aron Goldhirsch

  14. Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Aron Goldhirsch

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  1. Olivia Pagani
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  2. Karen N. Price
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  3. Richard D. Gelber
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  4. Monica Castiglione-Gertsch
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  5. Stig B. Holmberg
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  6. Jurij Lindtner
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  7. Beat Thürlimann
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  8. John Collins
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  9. Martin F. Fey
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  10. Alan S. Coates
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  11. Aron Goldhirsch
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International Breast Cancer Study Group (IBCSG)

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Correspondence to Olivia Pagani.

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Pagani, O., Price, K.N., Gelber, R.D. et al. Patterns of recurrence of early breast cancer according to estrogen receptor status: a therapeutic target for a quarter of a century. Breast Cancer Res Treat 117, 319–324 (2009). https://doi.org/10.1007/s10549-008-0282-0

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  • DOI: https://doi.org/10.1007/s10549-008-0282-0

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