annual recurrence rates for breast cancer--this time by ER status,# involved nodes,vi

[Lani]

http://www.springerlink.com/content/8082157643273172/

sorry, it didn't look at her2 it seems, but I will investigate further

[Margerie]

Are they looking at patients treated with surgery alone??

[Lani]

I am not sure. Maybe it is because they are Japanese! They certainly do not express themselves well!

They discuss how the ARR should influence how long one treats w tamoxifen, AIs, when to give chemotherapy, but do not specify the treatment(s) the breast cancer patients received, even as to whether they had BCS vs mastectomy, radiation therapy or not, tamoxifen vs AI, chemo /what type/or not.

That leads one to think perhaps they got no treatment other than surgery, ...but it is dangerous to make assumptions!

Perhaps next month's publication will have a letter to the editor regarding this!

[Hopeful]

Lani,

I was confused by the findings, as they seem opposite to everything else I have read re: ER+ vs. ER-. This paper says ER+ recurrences peak at 2 years, and that ER-'s peaked at 2 years then again at 6-7 years. This sounds like they have it reversed.

Hopeful

[Lani]

and as I said I read the full article 3 times and remain confused as it is very poorly presented.

Overall (ER+ and ER-s combined) recurrence peaked at 2 years and then the recurrence level stayed constant.

This illustrates my contention that it is best to delineate the recurrence rates of different types of breast cancer.

When separating out ER+ vs ER- the latter had two peaks and otherwise was much less likely to recur after 5 years. The former peaked at 2 years but continued to remain elevated many more years out than ER-, especially if there were a large no. of + lymph nodes. The vascular invasion part was particularly poorly worded, both in the abstract and in the article.

I have sort of given up on the article, but just posted it as many voice annoyance that there aren't better stats to give her2+ patients regarding their risk of recurrence and how it varies with time since surgery.

[Hopeful]

Lani,

Your explanation is more consistent with what I have read in other papers. I don't know if some of the issues are bad presentations or due to people trying to communicate in a language that is not their native tongue. Maybe a bit of both. Anyway, thanks for putting the effort into this.

Hopeful

[Becky]

Just want to clarify peak in recurrence rates.

They are the same for ER+ and ER- disease - 2 years. However, highly hormone positive bc also has another peak at about 7-8 yrs out (which is not as large as the 2 yr peak) that hormone negative disease does not have. All bc can recur years and years out but it really declines after about 4-5 years. It just rebounds again for the highly hormone positive. This probably substantiates how effect Tamoxifen is for ER+/PR+ disease and the use of another 5 yrs of Femara after 5 yrs of Tamoxifen.

[dlaxague]

Hi all,

Does anyone have access to the full text of this study? I just doesn't seem right. Backwards, as others are saying. Plus, it might have graphs in the full text. I do love graphs.

I have an older study on the same subject, with lovely and numerous graphs. The women did receive chemo but the hormonal treatment, if appropriate, was short. Still, it has beautiful graphs of recurrence rates done in different ways (showing higher, sharper peak for ER-), and also interesting differences in site of recurrence, depending upon hormone status. It's a PDF file - I don't know how to send it to the list. But if you're interested, let me know and I'll try to send it privately. It's from 2003, and is called "Estrogen Receptors and Distinct Patterns of Breast Cancer Relapse", and is from MD Anderson, with authors that include Buzdar and Hortobagyi.

Being ERPR negative, I've paid attention to recurrence contrast information stratified by hormonal status. As Lani says, most of these statistics look at just one factor and contrast that, when doing timing of recurrence stats. But I think that in general, it can be assumed that the more aggressive cancers would behave in a similar way regardless of characteristics that earn them that "badge". Higher, earlier risk of recurrence for the more-aggressive ones. Somewhat balanced by being relatively off the hook sooner, if that recurrence doesn't happen.

Debbie Laxague

Hi, I know this is an old post but wondered if anyone had any new views? It's 5 years 8 months since I was diagnosed and had yearly check last week, when I asked about increased recurrence rates for ER+ I was told that he felt that was not the case now and my risk at the moment would be the risk that would remain... I also asked about staying on Arimidex and was told I could have another year!

Thanks

ER+
Her2+
1 lymph node+

[tricia keegan]

I was wondering the same thing, and also in view of the fact that I have some bone loss on arimdex but highly triple pos and not sure if my onc will agree to me continuing to take it due to the bone loss.

[Jackie07]

I was told last summer to resume my Tamoxifen even though I'd finished the 5 years and had had oophorectomy 7 months prior. Then I found an article mentioning the continuing protecting effect of Tamoxifen after menopause.

Since Tamoxifen causes less bone loss for post menopausal women (there's even reports claiming that it has good effects on bones for post menopausal women), I wondered if it can be given to those who have had Aromatase Inhibitors such as Arimidex.

Trisha, I am also osteopenic and feel my stiff joints are getting worse but being in Scotland it could be the damp weather!!

Jackie, I thought Tamoxifen wasn't recommended for Her2+ and that after 5 years of Tamoxifen they were recommendind an AI?

[Jackie07]

I looked up the database and found some new researches that could be the basis of my oncologist's decision. [He 'mailed' the sticky note "just want to make sure you are taking Tamoxifen" with a prescription a day after my appointment last summer - obviously not wanting to spend time explain... ]

http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen
Under 2. How does Tamoxifen work:
Although tamoxifen acts against the effects of estrogen in breast tissue, it acts like estrogen in other tissue. This means that women who take tamoxifen may derive many of the beneficial effects of menopausal estrogen replacement therapy, such as a decreased risk of osteoporosis.


Eur J Cancer. 2010 Jun;46(9):1580-7. Epub 2010 Apr 21.
Prolonged tamoxifen treatment increases relapse-free survival for patients with primary breast cancer expressing high levels of VEGF.
Sanchez BC, Sundqvist M, Fohlin H, Spyratos F, Nordenskjöld B, Stål O, Linderholm BK.
Karolinska Biomics Center, Karolinska Institute and University Hospital, Stockholm, Sweden.
Abstract
Previous retrospective studies have shown that high intratumoural levels of vascular endothelial growth factor (VEGF) correlate with an inferior outcome for patients treated with adjuvant tamoxifen. Our objectives were to validate the impact of VEGF on survival after adjuvant tamoxifen and to investigate the interaction between VEGF and treatment duration. For this purpose tumour homogenates from 402 patients with operable oestrogen receptor positive breast cancer (BC), treated with tamoxifen for 2 (n=149) or 5 years (n=253) as the only systemic adjuvant therapy were included. The median follow-up time for surviving patients was 9.8 years (range 0.5-14.8 years). Expression of VEGF was assessed by an enzyme-linked immunosorbent assay and investigated in relation to the standard BC parameters and survival. In the total population, higher VEGF was significantly correlated with shorter recurrence-free survival (RFS) (HR=1.63, 95%CI=1.11-2.39, p=0.010), breast cancer corrected survival (BCCS) (HR=1.82, 95%CI=1.13-2.93, p=0.014) and overall survival (OS) (HR=1.51, 95%CI=1.11-2.05, p=0.009). High VEGF was significantly associated with reduced RFS (HR=2.61, 95%CI=1.45-4.70, p=0.001) after two years of tamoxifen, whilst no difference was seen in patients treated for five years (HR=1.09, 95%CI=0.64-1.84, p=0.760). A statistically significant interaction was observed between high VEGF expression and improved RFS after 5-year tamoxifen (p=0.034). In concordance with previous studies, high VEGF was significantly correlated with shorter survival. We present data not reported previously revealing that patients expressing high levels of VEGF display a better outcome provided that tamoxifen is given for five years. Further studies on the impact of VEGF on a 5-year regimen are motivated.

Breast. 2010 Apr;19(2):76-83. Epub 2010 Jan 21.
Aromatase inhibitors versus tamoxifen as adjuvant hormonal therapy for oestrogen sensitive early breast cancer in post-menopausal women: meta-analyses of monotherapy, sequenced therapy and extended therapy.
Josefsson ML, Leinster SJ.
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, United Kingdom. m.josefsson@doctors.org.uk
Abstract
Adjuvant tamoxifen reduces relapses and prolongs survival in patients with oestrogen sensitive breast cancer. Development of resistance is however common. Tamoxifen can be given for a maximum of five years; although the risk of recurrences remains high after this period. This review examines nine randomised controlled trials including 28,632 women, which studied aromatase inhibitors (AIs) as an alternative to tamoxifen in three treatment settings: monotherapy (instead of tamoxifen), sequenced therapy (tamoxifen is switched to an AI) and extended therapy (following adjuvant tamoxifen). Disease free survival was significantly improved for monotherapy (HR 0.89, [95% CI 0.83-0.96] p = 0.002) and sequenced therapy (HR 0.72, [0.63-0.83] p < 0.00001). There was no difference in overall survival for monotherapy (HR 0.94, [0.82-1.08] p = 0.39) or extended therapy (HR 0.86 [0.79-1.16] p = 0.67). Importantly, overall survival was prolonged for patients who switched from tamoxifen to AI therapy (HR 0.78 95%CI 0.68-0.91, p = 0.001).
Copyright 2009 Elsevier Ltd. All rights reserved.