Early discontinuation of endocrine therapy and recurrence of breast cancer among premenopausal women

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Lindsay J Collin, Emory University
  • ,
  • Deirdre Cronin-Fenton
  • Thomas P Ahern
  • Michael Goodman, Emory Univ, Emory University, Dept Chem
  • ,
  • Lauren E McCullough, Rollins School of Public Health
  • ,
  • Lance A Waller, Department of Systems Medicine and Center of Biostatistics and Bioinformatics, University of Rome Tor Vergata, Italy
  • ,
  • Anders Kjærsgaard
  • Per Damkier, Department of Clinical Biochemistry and Pharmacology
  • ,
  • Peer M Christiansen
  • Bent Ejlertsen, Experimental Oncology 2, Dept Molecular Oncology- CRO
  • ,
  • Maj-Britt Jensen, Danish Breast Cancer Group
  • ,
  • Henrik Toft Sørensen
  • Timothy L Lash

PURPOSE: Premenopausal women diagnosed with estrogen receptor (ER)-positive breast cancer are prescribed 5-10 years of endocrine therapy to prevent or delay recurrence. In this study, we evaluated the association between early discontinuation of endocrine therapy and breast cancer recurrence in a cohort of premenopausal women.

EXPERIMENTAL DESIGN: We identified 4,503 premenopausal ER+ breast cancer patients who initiated adjuvant endocrine therapy and were registered in the Danish Breast Cancer Group clinical database (2002-2011). Women were excluded if they had a recurrence or were lost to follow-up less than 1.5 years after breast cancer surgery. Endocrine therapy was considered complete if the patient received at least 4.5 years of treatment or discontinued medication less than 6 months before recurrence. Exposure status was updated annually and modeled as a time-dependent variable. We accounted for baseline and time-varying confounders via time-varying weights, which we calculated from multivariable logistic regression models, and included in regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) associating early discontinuation with recurrence.

RESULTS: Over the study follow-up, 1,001 (22%) women discontinued endocrine therapy. We observed 202 (20%) recurrences among those who discontinued endocrine therapy, and 388 (11%) among those who completed the recommended treatment. The multivariable-adjusted estimated rate of recurrence was higher in women who discontinued endocrine therapy relative to those who completed their treatment (HR=1.67, 95% CI 1.25, 2.14).

CONCLUSION: These results highlight the importance of clinical follow-up and behavioral interventions that support persistence of adjuvant endocrine therapy to prevent breast cancer recurrence.

OriginalsprogEngelsk
TidsskriftClinical Cancer Research
Vol/bind27
Nummer5
Sider (fra-til)1421-1428
Antal sider8
ISSN1078-0432
DOI
StatusUdgivet - mar. 2021

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