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-   -   New Article: 20-year risk of BC recurrence & length of endocrine therapy (https://her2support.org/vbulletin/showthread.php?t=66630)

karen z 11-08-2017 04:12 PM

New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
Published in NEJM (Nov. 9, 2017)
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ORIGINAL ARTICLE

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years
Hongchao Pan, Ph.D., Richard Gray, M.Sc., Jeremy Braybrooke, B.M., Ph.D., Christina Davies, B.M., B.Ch., Carolyn Taylor, B.M., B.Ch., Ph.D., Paul McGale, Ph.D., Richard Peto, F.R.S., Kathleen I. Pritchard, M.D., Jonas Bergh, M.D., Ph.D., Mitch Dowsett, Ph.D., and Daniel F. Hayes, M.D., for the EBCTCG*

N Engl J Med 2017; 377:1836-1846November 9, 2017DOI: 10.1056/NEJMoa1701830

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BACKGROUND
The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)–positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment.

METHODS
In this meta-analysis of the results of 88 trials involving 62,923 women with ER-positive breast cancer who were disease-free after 5 years of scheduled endocrine therapy, we used Kaplan–Meier and Cox regression analyses, stratified according to trial and treatment, to assess the associations of tumor diameter and nodal status (TN), tumor grade, and other factors with patients’ outcomes during the period from 5 to 20 years.

RESULTS
Breast-cancer recurrences occurred at a steady rate throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status. Among the patients with stage T1 disease, the risk of distant recurrence was 13% with no nodal involvement (T1N0), 20% with one to three nodes involved (T1N1–3), and 34% with four to nine nodes involved (T1N4–9); among those with stage T2 disease, the risks were 19% with T2N0, 26% with T2N1–3, and 41% with T2N4–9. The risk of death from breast cancer was similarly dependent on TN status, but the risk of contralateral breast cancer was not. Given the TN status, the factors of tumor grade (available in 43,590 patients) and Ki-67 status (available in 7692 patients), which are strongly correlated with each other, were of only moderate independent predictive value for distant recurrence, but the status regarding the progesterone receptor (in 54,115 patients) and human epidermal growth factor receptor type 2 (HER2) (in 15,418 patients in trials with no use of trastuzumab) was not predictive. During the study period from 5 to 20 years, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% for high-grade disease; the corresponding risks of any recurrence or a contralateral breast cancer were 17%, 22%, and 26%, respectively.

CONCLUSIONS
After 5 years of adjuvant endocrine therapy, breast-cancer recurrences continued to occur steadily throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status, with risks ranging from 10 to 41%, depending on TN status and tumor grade. (Funded by Cancer Research UK and others.)

Carol Ann 11-08-2017 08:32 PM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
I couldn't access the article ... it required a campus ID to sign in.

Carol Ann

rhondalea 11-10-2017 05:35 PM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
Uploaded to my Dropbox:

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

If the link goes bad, let me know. I sometimes move files without thinking about what it will do to my online links.

Carol Ann 11-12-2017 07:22 AM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
Rhonda,

Thank you so much for uploading this to your Dropbox!

Given I had not one but 2 tumors (one in each breast) plus DCIS ... I am probably going to stick with the 10 year plan. I am blessed not to have any joint pain (so far, anyway!) with the Arimidex.

But will definitely discuss with my onc when I get to the 5 year mark in April 2019. He has already said if I can manage the side effects, better to stay on it given my history.

My most UGH side effects are hot flashes and weight gain ... but I have managed to lose 40 pounds on the ketogenic diet, so I am sticking to that too.

I pray for all of us here every day.

Carol Ann

jaykay 11-13-2017 05:15 PM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
Ok, so a combo of er+ and her2+ stinks big time. I was on tamoxifen and letrozole for 10 years, happily anti-estrogen free for 18 months, then "kaboom", breast cancer again in other breast. Back on letrozole since 2013 and will never go off.

I pray for all of us, too. It takes a village....

Carol Ann 11-13-2017 08:05 PM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
It all stinks! Jaykay, what side effects have you had from the Letrozole?

What it takes besides prayers ... more $$ given to research on metastasis vs useless "awareness" programs. A person would have to be living in a cave and raised by wolves never to have heard of this disease in this day and age!

Carol Ann

jaykay 11-14-2017 07:25 AM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
Side effects from letrozole? Can't tell whether it's the letrozole or getting older, lol. I've been osteopenic for years (before BC) and have done the fosamax, actonel, reclast . My endocrinologist pulled me off the reclast since longer than 5 years seems to cause large bone fractures (like thigh bones).

I do know that my bone density has gotten worse since I've been back on letrozole but nothing I can do about that until I get full-fledged osteopenia and am eligible for something like prolia. I work out religiously - both cardio and weight bearing so that helps.

To answer your question - main effect is decreasing bone density. Aches and pains? A little but nothing I can't handle. Compared to tamoxifen, letrozole is a day at the beach

Carol Ann 11-14-2017 09:11 AM

Re: New Article: 20-year risk of BC recurrence & length of endocrine therapy
 
I am osteopenic as well ... but I was before everything started, even with weight lifting, etc. I take Fosamax once a week plus calcium, etc.

Thanks for your input on the Letrozole!

Carol Ann


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