Responses of clinicians regarding the decision on performing adjuvant endocrine therapy after adjuvant chemotherapy for premenopausal women.

Responses of clinicians regarding the decision on performing adjuvant endocrine therapy after adjuvant chemotherapy for premenopausal women.</p

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PurposeConsidering prognostic and anatomic stages in early-stage premenopausal patients with breast cancer, clinicians decide on performing the multigene assay, adjuvant chemotherapy, or ovarian function suppression (OFS). This decision is also based on genetic information related to hormone receptor-positive and human epidermal growth factor receptor 2 negative results. We aimed to determine the tendency to use adjuvant therapy in clinical practice.MethodsFrom April to May 2022, clinicians of the Korean Breast Cancer Society responded to a web-based survey. The survey included 62 multiple-choice questions mainly on decision-making under different pathologic conditions.ResultsAmong 92 responding clinicians, 91.3% were breast surgeons. For 35-year-old patients (pT2N0 and Ki-67 50% profile), 96.8% of clinicians selected chemotherapy, whereas 50.7% selected chemotherapy for patients with pT1N0, Ki-67 10%, and without Oncotype Dx (ODX). Only 35.6% selected chemotherapy for 47-year-old patients with the same profiles, while 84.3% and 49.1% chose chemotherapy with ODX recurrence score 21 and 16, respectively. More clinicians selected tamoxifen (TMX) plus OFS than aromatase inhibitor (AI) plus OFS for 5 years of endocrine therapy in patients with adjuvant chemotherapy regardless of genomic and clinical risks. However, for the same patients without adjuvant chemotherapy, more clinicians selected AI plus OFS. A longer duration of additional OFS and TMX was selected in patients with high clinical and genomic risks, and the duration of OFS was relatively shorter in older patients.ConclusionThe decision regarding adjuvant therapy should be made considering clinical and genomic risks and age, and clinicians should consult with patients about adverse effects and compliance.</div

Responses of clinicians regarding the decision on adding ovarian function suppression and tamoxifen with and without prior chemotherapy for premenopausal women.

Responses of clinicians regarding the decision on adding ovarian function suppression and tamoxifen with and without prior chemotherapy for premenopausal women.</p

Decision on tamoxifen (TMX) extension versus switching to aromatase inhibitor (AI) for patients with a change of menopausal status after 5-year-use of TMX (47-years-old).

For 47-year-old patients with a change of menopausal status after 5-year-use of TMX, 63.9% answered to switch from TMX to AI under the pathological condition of pT1N0 and Ki-67 10% with no ODX result, whereas 91.7% answered to switch from TMX to AI with the pathological condition of pT3N1 and Ki-67 70% without ODX result.</p

Duration of additional ovarian function suppression (OFS) in combination with tamoxifen for premenopausal women with or without adjuvant chemotherapy.

The x-axis represents each condition of the virtual patient, whereas the y-axis represents the response percentages. (a) Duration of additional OFS in 35-year-old patients with or without adjuvant chemotherapy; 56.8% of clinicians selected to include OFS for 5 years for pT1N0, Ki-67 10%, Oncotype Dx recurrence score (ODX RS) 16, whereas 63.2% selected to include OFS for 5 years for patients without prior chemotherapy under equal pathological conditions. At a higher Ki-67 grade with ODX RS 21, 68.4% and 81.6% of clinicians selected to include OFS for 5 years with and without prior chemotherapy, respectively. (b) Duration of additional OFS in 47-year-old patients with or without adjuvant chemotherapy; 57.9% of clinicians selected to include OFS for only 2 years for pT2N0, Ki-67 10%, ODX 16, whereas 52.6% selected to include OFS for patients without prior chemotherapy under same pathological conditions. Further, 50.0% selected to include OFS for 2 years for pT1N1, Ki-67 10%, and low-risk profile from the MammaPrint assay and finished adjuvant chemotherapy in advance, whereas 50.0% answered to add OFS for 5 years without prior chemotherapy under same pathological condition.</p

Specialty of clinicians who provided full responses.

A total of 92 clinicians responded to the survey; among these, 91.3% (84/92) were breast surgeons, and 7.6% (7/92) were oncologists. We did not receive a reply from any radiologist.</p

Responses of clinicians regarding the decision on performing adjuvant endocrine therapy without prior adjuvant chemotherapy for premenopausal women.

Responses of clinicians regarding the decision on performing adjuvant endocrine therapy without prior adjuvant chemotherapy for premenopausal women.</p

Responses of clinicians regarding the decision on adjuvant chemotherapy for premenopausal women.

Responses of clinicians regarding the decision on adjuvant chemotherapy for premenopausal women.</p

Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer

<div><p>The aim of this study was to determine the relationship between the body mass index (BMI) at a breast cancer diagnosis and various factors including the hormone-receptor, menopause, and lymph-node status, and identify if there is a specific patient subgroup for which the BMI has an effect on the breast cancer prognosis. We retrospectively analyzed the data of 8,742 patients with non-metastatic invasive breast cancer from the research database of Asan Medical Center. The overall survival (OS) and breast-cancer-specific survival (BCSS) outcomes were compared among BMI groups using the Kaplan-Meier method and Cox proportional-hazards regression models with an interaction term. There was a significant interaction between BMI and hormone-receptor status for the OS (<i>P</i> = 0.029), and BCSS (<i>P</i> = 0.013) in lymph-node-positive breast cancers. Obesity in hormone-receptor-positive breast cancer showed a poorer OS (adjusted hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 0.92 to 2.48) and significantly poorer BCSS (HR = 1.80, 95% CI = 1.08 to 2.99). In contrast, a high BMI in hormone-receptor-negative breast cancer revealed a better OS (HR = 0.44, 95% CI = 0.16 to 1.19) and BCSS (HR = 0.53, 95% CI = 0.19 to 1.44). Being underweight (BMI < 18.50 kg/m²) with hormone-receptor-negative breast cancer was associated with a significantly worse OS (HR = 1.98, 95% CI = 1.00–3.95) and BCSS (HR = 2.24, 95% CI = 1.12–4.47). There was no significant interaction found between the BMI and hormone-receptor status in the lymph-node-negative setting, and BMI did not interact with the menopause status in any subgroup. In conclusion, BMI interacts with the hormone-receptor status in a lymph-node-positive setting, thereby playing a role in the prognosis of breast cancer.</p></div

Overall survival and breast-cancer-specific survival curves for the hormone-receptor-positive breast cancer patients according to the four body mass index groups.

<p>(A) Overall survival. (B) Breast-cancer-specific survival.</p