Journal Article
. 2017 Jun;96(22).
doi: 10.1097/MD.0000000000006777.

Adjuvant endocrine therapy alone in patients with node-positive, luminal A type breast cancer

Sungmin Park 1 Se Kyung Lee  Hyun-June Paik  Jai Min Ryu  Isaac Kim  Soo Youn Bae  Jonghan Yu  Seok Won Kim  Jeong Eon Lee  Seok Jin Nam  
  • PMID: 28562530
  •     22 References
  •     4 citations


Luminal A breast cancer has a much better prognosis than other subtypes, with a low risk of local or regional recurrence. However, there is controversy around under- versus overtreatment with regard to adjuvant treatment of node-positive, luminal A breast cancer. The purpose of this study was to identify whether adjuvant systemic chemotherapy has any benefit in node-positive, luminal A breast cancer and to evaluate feasibility of endocrine therapy without chemotherapy in this group.This was a retrospective study of 11,025 patients who were surgically treated for invasive breast cancer at Samsung Medical Center between January 2004 and December 2013. Luminal A subtype was defined as ER+, HER2-, and Ki-67 < 14%. We compared AC based (AC: doxorubicin or epirubicin, plus cyclophosphamide) adjuvant chemotherapy versus endocrine therapy without chemotherapy in patients with node-positive, luminal A breast cancer.We performed 1: n matching, with a maximum n of 8 on endocrine therapy group (n = 50) to chemotherapy group (n = 642). The median age of the patients in each group at the time of surgery was 58.3 ± 9.5 years in the chemotherapy group and 58.7 ± 11.7 in the endocrine therapy only group. The median follow-up time was 51.9 months (range, 1-125 months). In multivariable analysis, omission of adjuvant chemotherapy in luminal A cancer had no influence on OS and DFS. Axillary lymph node metastasis and progesterone receptor (PR) status were significantly different between the endocrine therapy alone group and the chemotherapy group in terms of OS. Nuclear grade, PR status, and adjuvant radiotherapy were significantly different between the endocrine therapy alone group and the chemotherapy group with regard to DFS. In survival analysis, there were no differences in OS (P = .137) and DFS (P = .225) between the 2 groups.Adjuvant chemotherapy could provide little benefit to postmenopausal patients with luminal A, node-positive breast cancer, and endocrine therapy alone may help reduce morbidity. Future studies with a large number of patients and longer follow-up time are necessary to determine whether chemotherapy might be avoided in this patient population.

Is adjuvant chemotherapy omissible in women with T1-2 stage, node-positive, luminal A type breast cancer?
Hee Yong Kwak, Byung Joo Chae, +5 authors, Byung Joo Song.
J Chemother, 2015 May 15; 27(5). PMID: 25974160
Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG), R Peto, +15 authors, K Pritchard.
Lancet, 2011 Dec 14; 379(9814). PMID: 22152853    Free PMC article.
Highly Cited.
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark.
J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680
Highly Cited.
Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG).
Lancet, 2005 May 17; 365(9472). PMID: 15894097
Highly Cited.
Integrating comparative effectiveness design elements and endpoints into a phase III, randomized clinical trial (SWOG S1007) evaluating oncotypeDX-guided management for women with breast cancer involving lymph nodes.
Scott D Ramsey, William E Barlow, +6 authors, Gabriel N Hortobagyi.
Contemp Clin Trials, 2012 Sep 25; 34(1). PMID: 23000081    Free PMC article.
Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011.
A Goldhirsch, W C Wood, +4 authors, Panel members.
Ann Oncol, 2011 Jun 29; 22(8). PMID: 21709140    Free PMC article.
Highly Cited.
Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal A breast cancer.
Aleix Prat, Maggie Chon U Cheang, +8 authors, Charles M Perou.
J Clin Oncol, 2012 Dec 13; 31(2). PMID: 23233704    Free PMC article.
Highly Cited.
Single agent versus combination chemotherapy for metastatic breast cancer.
Sue Carrick, Sharon Parker, +3 authors, Nicholas Wilcken.
Cochrane Database Syst Rev, 2009 Apr 17; (2). PMID: 19370586    Free PMC article.
Systematic Review.
Axillary lymph nodes and breast cancer: a review.
A Recht, M J Houlihan.
Cancer, 1995 Nov 01; 76(9). PMID: 8635050
An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies.
Peter C Austin.
Multivariate Behav Res, 2011 Aug 06; 46(3). PMID: 21818162    Free PMC article.
Highly Cited.
Significance of axillary lymph node metastasis in primary breast cancer.
I Jatoi, S G Hilsenbeck, G M Clark, C K Osborne.
J Clin Oncol, 1999 Nov 24; 17(8). PMID: 10561295
Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results.
Joyce O'Shaughnessy, David Miles, +11 authors, Robert Leonard.
J Clin Oncol, 2002 Jun 18; 20(12). PMID: 12065558
Highly Cited.
Prediction of adjuvant chemotherapy benefit in endocrine responsive, early breast cancer using multigene assays.
Kathy S Albain, Soonmyung Paik, Laura van't Veer.
Breast, 2009 Nov 17; 18 Suppl 3. PMID: 19914534
Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193).
George W Sledge, Donna Neuberg, +4 authors, William C Wood.
J Clin Oncol, 2003 Feb 15; 21(4). PMID: 12586793
Highly Cited.
Fighting overtreatment in adjuvant breast cancer therapy.
Michael Gnant, Guenther G Steger.
Lancet, 2009 Dec 17; 374(9707). PMID: 20004965
Targeting adjuvant chemotherapy: a good idea that needs to be proven!
Daniel F Hayes.
J Clin Oncol, 2012 Feb 23; 30(12). PMID: 22355050
Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial.
Kathy S Albain, William E Barlow, +20 authors, Breast Cancer Intergroup of North America.
Lancet Oncol, 2009 Dec 17; 11(1). PMID: 20005174    Free PMC article.
Highly Cited.
Gene-expression signatures in breast cancer.
Christos Sotiriou, Lajos Pusztai.
N Engl J Med, 2009 Feb 21; 360(8). PMID: 19228622
Highly Cited. Review.
Development of the 21-gene assay and its application in clinical practice and clinical trials.
Joseph A Sparano, Soonmyung Paik.
J Clin Oncol, 2008 Feb 09; 26(5). PMID: 18258979
Highly Cited. Review.
Identification of a Low-Risk Luminal A Breast Cancer Cohort That May Not Benefit From Breast Radiotherapy.
Fei-Fei Liu, Wei Shi, +11 authors, Anthony W Fyles.
J Clin Oncol, 2015 May 13; 33(18). PMID: 25964246
The 70-gene prognosis-signature predicts disease outcome in breast cancer patients with 1-3 positive lymph nodes in an independent validation study.
Stella Mook, Marjanka K Schmidt, +10 authors, TRANSBIG Consortium.
Breast Cancer Res Treat, 2008 Jul 29; 116(2). PMID: 18661261
Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients.
Lisa K Dunnwald, Mary Anne Rossing, Christopher I Li.
Breast Cancer Res, 2007 Jan 24; 9(1). PMID: 17239243    Free PMC article.
Highly Cited.
Prognostic and clinicopathological value of Twist expression in breast cancer: A meta-analysis.
Weiqiang Qiao, Zhiqiang Jia, +6 authors, Sanqiang Li.
PLoS One, 2017 Oct 11; 12(10). PMID: 29016671    Free PMC article.
Gene expression assay and Watson for Oncology for optimization of treatment in ER-positive, HER2-negative breast cancer.
Yun Yeong Kim, Se Jeong Oh, +2 authors, Heung Kyu Park.
PLoS One, 2018 Jul 07; 13(7). PMID: 29979736    Free PMC article.
CXCR4 and CXCR3 are two distinct prognostic biomarkers in breast cancer: Database mining for CXCR family members.
Kaibo Guo, Guan Feng, +5 authors, Shanming Ruan.
Mol Med Rep, 2019 Nov 09; 20(6). PMID: 31702806    Free PMC article.
Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis.
Yilun Li, Li Ma.
World J Surg Oncol, 2020 Dec 04; 18(1). PMID: 33267822    Free PMC article.