Young Breast Cancer Patients Can Have Good Outcomes With Recommended Therapies

Breast cancer is more aggressive in young women compared to older ones. However, if treatments based on established guidelines are adhered to, then the outcomes can be good and better in young women with breast cancer, reveals a new study. The results are based on the findings of two studies, one from Portugal and the other from Switzerland, which investigate the aggressiveness and recurrence of breast cancer in young women, respectively.

The study findings are being presented at the European Society for Medical Oncology (ESMO) Breast Cancer Congress 2019 in Berlin, Germany.

In this regard, ESMO Spokesman Dr. Matteo Lambertini, MD, PhD, from IRCCS Policlinico San Martino Hospital, University of Genoa, Italy, said: “Women under 40 years of age tend to be diagnosed with more aggressive breast cancer types - for example their tumors are more likely to be triple negative and HER2 positive. Despite this, survival and local recurrence rates are similar to those of the general population of breast cancer patients provided they receive appropriate treatment.”

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Study 1: Breast Cancer in Young Women - A Multi-Center 10-Year Experience

Study Aims

Characterization of a cohort of young women with breast cancer with reference to incidence, biology, tumor stage, treatment, and survival.

Study Methods

• This was a retrospective, multi-center study, conducted between 2008-2017
• All breast cancer patients were below 35 years of age
• The study included 207 patients from 5 centers
• 35 patients were excluded from the study due to the following reasons:
• 27 due to lack of data
• 1 due to two different synchronous tumors
• 7 due to ductal in situ carcinoma
• Data were analyzed using the Statistical Package for the Social Sciences (SPSS, IBM, USA)

Study Findings

• The median age of the patients was 31 years
• The most common (91%) histological subtype was ductal invasive carcinoma
• The tumors were categorized into the following subtypes:
• 4 percent: Luminal A
• 20 percent: Luminal B HER2 positive
• 47 percent: Luminal B HER2 negative
• 8 percent: HER2 positive
• 21 percent: Triple negative
• 48 percent of patients were diagnosed with early stage breast cancer
• 45 percent of patients had locally advanced breast cancer
• 6 percent of patients had de novo metastatic breast cancer
• 39 percent of patients underwent neoadjuvant chemotherapy (CT), of which 12 percent gave a complete response
• 83 percent of patients underwent adjuvant systemic therapy (CT or endocrine therapy)
• 18 percent exclusively underwent endocrine therapy
• The median follow-up time was 53.5 months
• 37 patients developed metastatic breast cancer
• The median survival time was 16.5 months for metastatic breast cancer
• 3 patients had a local recurrence with a median time of 27 months
• 85 percent of the patients were alive at the time of termination of the study

Dr. Ines F. Eiriz, the presenting author, attached to the Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal, said: “Disease-free survival was longest in women with hormone receptor-positive tumors, followed by those with HER2 positive disease, and lastly those with triple negative breast cancer. The median survival of patients without metastases was 130 months compared to 16.5 months for those with metastatic disease.”

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Study 2: Breast Cancer Early Recurrences in Young Women

Study Aims

Analysis of rates of recurrence of cancer in young breast cancer patients.

Study Methods

• This was a retrospective study conducted between 2010-2017
• Medical records of 381 women ≤ 50 years were analyzed
• The women were undergoing treatment for Stage I-III invasive breast cancer
• The following parameters were assessed:
• Demographics
• Tumor biology
• Type of surgery
• Neoadjuvant/adjuvant therapy
• Site/time of recurrence
• Survival
• Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier survival curves

Study Findings

• The median age of the patients was 45 years
• The median follow-up time was 45.6 months
• 22 patients (5.8%) were lost to follow-up
• 29 patients (7.6%) relapsed, among which 9 died
• 2 patients developed a second tumor in the contralateral breast
• The median interval to recurrence was 31 months
• The 3-year and 5-year risk for loco-regional recurrence was 4.7 percent and 9.5 percent respectively
• The 3-year and 5-year DFS was 94.3 percent and 91.2 percent respectively
• The 5-year OS was 93.3 percent

Dr. Simona Cima, the presenting author, attached to the IOSI - Oncology Institute of Southern Switzerland, Bellinzona, Switzerland, said: “Most recurrences in these patients were local rather than metastatic. Our study is ongoing, and the next step is to identify the predictors of local recurrence. For example, we will examine the likelihood of local recurrence according to HER2 and triple negative status.”

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Conclusion

The findings of the two studies indicate that being diagnosed with breast cancer at a younger age does not necessarily mean lower survival or higher chances of recurrence. Importantly, proper guideline-recommended treatments should be administered to all breast cancer patients, irrespective of age, with due attention to possible side-effects of anticancer therapies, including infertility.

References:

1. Breast Cancer in Young Women: Good Outcomes with Advised Therapy  - (https://www.esmo.org/Press-Office/Press-Releases/Breast-cancer-young-women-aggressiveness-recurrence-Cima-Eiriz)
2. Ines F. Eiriz, Breast Cancer in Young Women - A Multi-Center 10-Year Experience, Annals of Oncology, Volume 30, 2019 Supplement 3.
3. Simona Cima, Breast Cancer Early Recurrences in Young Women, Annals of Oncology, Volume 30, 2019 Supplement 3.

Source-Medindia