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Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study.

https://arctichealth.org/en/permalink/ahliterature127527
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Publication Type
Article
Date
May-2012
Author
Annette Wigertz
Johan Ahlgren
Marit Holmqvist
Tommy Fornander
Jan Adolfsson
Henrik Lindman
Leif Bergkvist
Mats Lambe
Author Affiliation
Regional Cancer Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden. Annette.Wigertz@akademiska.se
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Hormonal - therapeutic use
Aromatase Inhibitors - therapeutic use
Breast Neoplasms - prevention & control
Chemotherapy, Adjuvant
Female
Humans
Logistic Models
Maintenance Chemotherapy
Medication Adherence - statistics & numerical data
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local - prevention & control
Neoplasms, Hormone-Dependent - prevention & control
Sweden
Tamoxifen - therapeutic use
Abstract
Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.
PubMed ID
22286315 View in PubMed
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Age-specific trends of survival in metastatic breast cancer: 26 years longitudinal data from a population-based cancer registry in Stockholm, Sweden.

https://arctichealth.org/en/permalink/ahliterature101025
Source
Breast Cancer Res Treat. 2011 May 27;
Publication Type
Article
Date
May-27-2011
Author
Theodoros Foukakis
Tommy Fornander
Tobias Lekberg
Henrik Hellborg
Jan Adolfsson
Jonas Bergh
Author Affiliation
Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden, theodoros.foukakis@ki.se.
Source
Breast Cancer Res Treat. 2011 May 27;
Date
May-27-2011
Language
English
Publication Type
Article
Abstract
Treatment of metastatic breast cancer (MBC) has evolved during the last decades but it is largely unknown whether this has led to improved survival in the general MBC population. Based on the regional, population-based breast cancer registry, we identified 5,463 patients diagnosed with MBC in Stockholm County during 1979-2004. Patients were divided into five cohorts based on the year of first MBC diagnosis and observed and relative survival were compared across the cohorts after adjustment for potential confounders. A significant trend of better survival over time was demonstrated for patients 60 years or younger (P 
PubMed ID
21617918 View in PubMed
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BRCA1 mutations in a population-based study of breast cancer in Stockholm County.

https://arctichealth.org/en/permalink/ahliterature17521
Source
Genet Test. 2004;8(2):127-32
Publication Type
Article
Date
2004
Author
Sara Margolin
Barbro Werelius
Tommy Fornander
Annika Lindblom
Author Affiliation
Department of Oncology, Huddinge University Hospital, Södersjukhuset, S 118 83 Stockholm, Sweden. sara.margolin@kus.se
Source
Genet Test. 2004;8(2):127-32
Date
2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
BRCA1 Protein - genetics
BRCA2 Protein - genetics
Breast Neoplasms - epidemiology - genetics
Female
Humans
Middle Aged
Mutation
Pedigree
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Abstract
The mutation frequency of BRCA1 and BRCA2 in women with breast cancer varies according to family history, age at diagnosis and ethnicity. The contribution of BRCA1 and BRCA2 mutations in breast cancer populations, unselected for age and family history, has been examined in several studies reporting mutation frequencies between 1% and 12% by screening methods, population sizes, and to what extent the gene/s were screened differed in the studies. We wanted to clarify the proportion of breast cancer attributable to mutations in BRCA1 in an unselected breast cancer population from the Stockholm region. All incident breast cancer patients treated surgically in a 19-month period were eligible for the study and 70% (489/696) participated. Exon 11 of BRCA1 was screened for mutations using the protein truncation test, and the mutation frequency was estimated from that. In previous studies on high-risk families from Stockholm, more than 70% of the mutations were detected in exon 11. Two mutations were found, both in patients with a family history or their own medical history of ovarian cancer, giving a mutation frequency in exon 11 of 0.4% and an estimated BRCA1 mutation frequency of
PubMed ID
15345109 View in PubMed
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Can breast cancer register data on recommended adjuvant treatment be used as a proxy for actually given treatment?

https://arctichealth.org/en/permalink/ahliterature283061
Source
Eur J Oncol Nurs. 2016 Jun;22:1-7
Publication Type
Article
Date
Jun-2016
Author
Agneta Wennman-Larsen
Marie I Nilsson
Fredrik Saboonchi
Mariann Olsson
Kristina Alexanderson
Tommy Fornander
Kerstin Sandelin
Lena-Marie Petersson
Source
Eur J Oncol Nurs. 2016 Jun;22:1-7
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - epidemiology - pathology - therapy
Carcinoma - epidemiology - pathology - therapy
Chemotherapy, Adjuvant
Female
Humans
Mastectomy
Middle Aged
Radiotherapy, Adjuvant
Registries
Sweden - epidemiology
Young Adult
Abstract
To study agreement between recommended adjuvant treatment after primary breast cancer (BC) surgery from the clinical based National Breast Cancer Register and initiated adjuvant treatment from medical records; factors associated with agreement; and reasons for discontinuation or change of planned treatment.
Included were 970 women who had undergone BC surgery, aged 20-63 years, living in Stockholm County, and literate in Swedish.
Distant metastases, pre-surgical chemotherapy, and/or a previous BC diagnosis. Information on clinical tumor stage, surgical treatment, recommended adjuvant radiotherapy, chemotherapy, and endocrine therapy was obtained from the BC register. Type of initiated adjuvant treatments, if treatment plan was followed, and reasons for discontinuation were extracted from medical records.
The register had high completeness and agreement was high, 94-96%, (? 0.801-0.908) for all types of treatment. Disagreement regarding radiotherapy and chemotherapy was associated with having =1 lymph node metastases and more extended axillary surgery, and for radiotherapy also more extended breast surgery. There were no such associations with age, tumor size, or invasiveness. None of these factors were associated with disagreement regarding recommended versus initiated endocrine therapy. Endocrine therapy was most often discontinued (24%), mostly due to toxicity which was also the most common reason for discontinuation of chemotherapy.
Swedish register data on recommended treatment has high validity in women aged 24-63 years, with limited BC, and demonstrates utility as a proxy for initiated treatment in this group. This is of interest since extracting data from medical records is resource demanding.
PubMed ID
27179887 View in PubMed
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Effect of Tailored Dose-Dense Chemotherapy vs Standard 3-Weekly Adjuvant Chemotherapy on Recurrence-Free Survival Among Women With High-Risk Early Breast Cancer: A Randomized Clinical Trial.

https://arctichealth.org/en/permalink/ahliterature277996
Source
JAMA. 2016 Nov 08;316(18):1888-1896
Publication Type
Article
Date
Nov-08-2016
Author
Theodoros Foukakis
Gunter von Minckwitz
Nils-Olof Bengtsson
Yvonne Brandberg
Birgitta Wallberg
Tommy Fornander
Brigitte Mlineritsch
Sabine Schmatloch
Christian F Singer
Günther Steger
Daniel Egle
Eva Karlsson
Lena Carlsson
Sibylle Loibl
Michael Untch
Mats Hellström
Hemming Johansson
Harald Anderson
Per Malmström
Michael Gnant
Richard Greil
Volker Möbus
Jonas Bergh
Source
JAMA. 2016 Nov 08;316(18):1888-1896
Date
Nov-08-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibiotics, Antineoplastic - administration & dosage - adverse effects
Antineoplastic Agents - administration & dosage - adverse effects - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - administration & dosage - adverse effects - therapeutic use
Austria
Breast Neoplasms - drug therapy - mortality - pathology
Chemotherapy, Adjuvant - adverse effects - methods
Cyclophosphamide - administration & dosage
Disease-Free Survival
Drug Administration Schedule
Epirubicin - administration & dosage
Female
Fluorouracil - administration & dosage
Germany
Humans
Middle Aged
Neoplasm Recurrence, Local
Quality of Life
Sweden
Taxoids - administration & dosage
Abstract
Standard dosing of chemotherapy based on body surface area results in marked interpatient variation in pharmacokinetics, toxic effects, and efficacy. Whether tailored dosing can improve outcomes is unknown, as is the role of dose-dense adjuvant chemotherapy.
To determine whether tailored dose-dense adjuvant chemotherapy improves the outcomes of early breast cancer compared with a standard 3-weekly chemotherapy schedule.
A randomized, open-label, phase 3 trial of women aged 65 years and younger who had surgery for nonmetastatic node-positive or high-risk node-negative breast cancer at 86 sites in Sweden, Germany, and Austria between February 20, 2007, and September 14, 2011.
Patients were randomized 1:1 either to 4 cycles of leukocyte nadir-based tailored and dose-dense adjuvant epirubicin and cyclophosphamide every 2 weeks followed by 4 cycles of tailored dose-dense docetaxel every 2 weeks, or to standard-interval chemotherapy with 3 cycles of fluorouracil and epirubicin-cyclophosphamide every 3 weeks followed by 3 cycles of docetaxel every 3 weeks.
The primary end point was breast cancer recurrence-free survival (BCRFS). Secondary end points included 5-year event-free survival (EFS), distant disease-free survival (DDFS), overall survival (OS), and rates of grade 3 or 4 toxic effects.
Among 2017 randomized patients (1006 in the tailored dose-dense group and 1011 in the control group; median [IQR] age, 51 [45-58] years; 80% with hormone receptor-positive tumors; 97% with node-positive disease), 2000 received study treatment (=1 cycle of chemotherapy; 1001 in the tailored dose-dense group and 999 in the control group). After a median follow-up of 5.3 years (IQR, 4.5-6.1 years), 269 BCRFS events were reported, 118 in the tailored dose-dense group and 151 in the control group (HR, 0.79; 95% CI, 0.61-1.01; log-rank P?=?.06; 5-year BCRFS, 88.7% vs 85.0%). The tailored dose-dense group had significantly better EFS than the control group (HR, 0.79; 95% CI, 0.63-0.99; P?=?.04; 5-year EFS, 86.7% vs 82.1%). The groups did not differ in OS (HR, 0.77; 95% CI, 0.57-1.05; P?=?.09; 5-year OS, 92.1% vs 90.2%) or DDFS (HR, 0.83; 95% CI, 0.64-1.08; P?=?.17; 5-year DDFS, 89.4% vs 86.7%). Grade 3 or 4 nonhematologic toxic effects occurred in 527 (52.6%) in the tailored dose-dense group and 366 (36.6%) in the control group.
Among women with high-risk early breast cancer, the use of tailored dose-dense chemotherapy compared with standard adjuvant chemotherapy did not result in a statistically significant improvement in breast cancer recurrence-free survival. Nonhematologic toxic effects were more frequent in the tailored dose-dense group.
clinicaltrials.gov Identifier: NCT00798070; isrctn.org Identifier: ISRCTN39017665.
Notes
Comment In: JAMA. 2016 Nov 8;316(18):1877-187827723886
PubMed ID
27825007 View in PubMed
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Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial.

https://arctichealth.org/en/permalink/ahliterature121621
Source
Eur J Cancer. 2013 Jan;49(1):52-9
Publication Type
Article
Date
Jan-2013
Author
Mia Fahlén
Tommy Fornander
Hemming Johansson
Ulla Johansson
Lars-Erik Rutqvist
Nils Wilking
Eva von Schoultz
Author Affiliation
Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden. mia.fahlen@capio.se
Source
Eur J Cancer. 2013 Jan;49(1):52-9
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - chemically induced
Female
Follow-Up Studies
Hormone Replacement Therapy - adverse effects
Humans
Incidence
Middle Aged
Neoplasm Recurrence, Local - chemically induced
Progestins - adverse effects
Sweden
Treatment Outcome
Abstract
The management of hormonal deficiency symptoms in breast cancer survivors is an unsolved problem. While hormone replacement therapy (HRT) may increase the risk of breast cancer in healthy women, its effects on recurrence is unclear. Observational studies have suggested decreased recurrence rates from HRT. The few clinical trials in this field have all been closed preterm.
The Stockholm trial was started in 1997 and designed to minimise the dose of progestogen in the HRT arm. Disease-free women with a history of breast cancer were randomised to HRT (n=188) or no HRT (n=190). The trial was stopped in 2003 when another Swedish study (HABITS, the Hormonal Replacement After Breast Cancer - Is it Safe?) reported increased recurrence. However the Stockholm material showed no excess risk after 4 years of follow-up. A long term follow-up has now been performed.
After 10.8 years of follow-up, there was no difference in new breast cancer events: 60 in the HRT group versus 48 among controls (hazard ratio (HR)=1.3; 95% confidence interval (CI)=0.9-1.9). Among women on HRT, 11 had local recurrence and 12 distant metastases versus 15 and 12 for the controls. There were 14 contra-lateral breast cancers in the HRT group and four in the control group (HR=3.6; 95% CI=1.2-10.9; p=0.013). No differences in mortality or new primary malignancies were found.
The number of new events did not differ significantly between groups, in contrast to previous reports. The increased recurrence in HABITS has been attributed to higher progestogen exposure. As both trials were prematurely closed, data do not allow firm conclusions. Both studies found no increased mortality from breast cancer or other causes from HRT. Current guidelines typically consider HRT contraindicated in breast cancer survivors. Findings suggest that, in some women symptom relief may outweigh the potential risks of HRT.
PubMed ID
22892060 View in PubMed
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Impact of comorbidity on management and mortality in women diagnosed with breast cancer.

https://arctichealth.org/en/permalink/ahliterature122319
Source
Breast Cancer Res Treat. 2012 Aug;135(1):281-9
Publication Type
Article
Date
Aug-2012
Author
Anders Berglund
Annette Wigertz
Jan Adolfsson
Johan Ahlgren
Tommy Fornander
Fredrik Wärnberg
Mats Lambe
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77 Stockholm, Sweden. anders.berglund@ki.se
Source
Breast Cancer Res Treat. 2012 Aug;135(1):281-9
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - therapeutic use
Breast Neoplasms - epidemiology - mortality - therapy
Cause of Death
Comorbidity
Disease Management
Female
Health status
Humans
Mastectomy, Segmental
Risk
Sweden - epidemiology
Tamoxifen - therapeutic use
Treatment Outcome
Abstract
To investigate associations between comorbidity burden, management, and mortality in women with breast cancer. A total of 42,646 women diagnosed with breast cancer between 1992 and 2008 were identified in two Clinical Quality Registers in Central Sweden. Breast cancer-specific, conditional breast cancer, competing-cause and all-cause mortality were estimated in relation to comorbidity burden assessed by the Charlson comorbidity index. All analyses were stratified by stage at diagnosis using competing risk analyses, and all-cause mortality was estimated as a function of follow-up time. Following adjustment for age and calendar period, breast conserving surgery was significantly less likely to be offered to women with severe comorbidity (OR 0.63; 95 % CI 0.58-0.69). Similarly, the proportion treated with radiotherapy, tamoxifen, or chemotherapy was lower in women with severe compared to those with no comorbidity. In women with early stage disease, breast cancer-specific mortality was higher among patients with severe comorbidity (sHR 1.47; 95 % CI 1.11-1.94). In all stages of breast cancer, conditional breast cancer and competing-cause mortality were elevated in women with severe comorbidity. For all stages, the relative risk of all-cause mortality between women with severe versus no comorbidity varied by time since diagnosis, and was most pronounced at early follow-up. Comorbidity affects treatment decisions and mortality. In women with early stage breast cancer, severe comorbidity was associated not only with conditional breast cancer, competing-cause and all-cause mortality, but also breast cancer-specific mortality. The observed differences in breast cancer-specific mortality may be due to less extensive treatment, impaired tumor defense and differences in general health status and lifestyle factors.
PubMed ID
22829398 View in PubMed
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Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden.

https://arctichealth.org/en/permalink/ahliterature101487
Source
Radiother Oncol. 2011 Jul 11;
Publication Type
Article
Date
Jul-11-2011
Author
Paul McGale
Sarah C Darby
Per Hall
Jan Adolfsson
Nils-Olof Bengtsson
Anna M Bennet
Tommy Fornander
Bruna Gigante
Maj-Britt Jensen
Richard Peto
Kazem Rahimi
Carolyn W Taylor
Marianne Ewertz
Author Affiliation
Clinical Trial Service Unit, University of Oxford, UK.
Source
Radiother Oncol. 2011 Jul 11;
Date
Jul-11-2011
Language
English
Publication Type
Article
Abstract
PURPOSE: To study incidence of radiation-related heart disease in a large population of breast cancer patients followed for up to 30years. MATERIAL AND METHODS: 72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976-2006 and followed prospectively. Radiation-related risk was studied by comparing women with left-sided and right-sided tumours. RESULTS: 34,825 women (48%) received radiotherapy. Among unirradiated women tumour laterality had little relevance to heart disease. Among irradiated women mean dose to the whole heart was 6.3Gy for left-sided tumours and 2.7Gy for right-sided tumours. Mortality was similar in irradiated women with left-sided and right-sided tumours, but incidence ratios, left-sided versus right-sided, were raised: acute myocardial infarction 1.22 (95% CI 1.06-1.42), angina 1.25 (1.05-1.49), pericarditis 1.61 (1.06-2.43), valvular heart disease 1.54 (1.11-2.13). Incidence ratios for all heart disease were as high for women irradiated since 1990 (1.09 [1.00-1.19]) as for women irradiated during 1976-1989 (1.08 [0.99-1.17]), and were higher for women diagnosed with ischaemic heart disease prior to breast cancer than for other women (1.58 [1.19-2.10] versus 1.08 [1.01-1.15], p for difference=0.01). CONCLUSIONS: Breast cancer radiotherapy has, at least until recently, increased the risk of developing ischaemic heart disease, pericarditis and valvular disease. Women with ischaemic heart disease before breast cancer diagnosis may have incurred higher risks than others.
PubMed ID
21752480 View in PubMed
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Placental weight and mortality in premenopausal breast cancer by tumor characteristics.

https://arctichealth.org/en/permalink/ahliterature119001
Source
Breast Cancer Res Treat. 2013 Jan;137(1):297-305
Publication Type
Article
Date
Jan-2013
Author
Mohammad Hossein Hajiebrahimi
Shahram Bahmanyar
Mats Lambe
Jan Adolfsson
Tommy Fornander
Fredrik Wärnberg
Sven Cnattingius
Author Affiliation
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden. Mohammadhossein.Hajiebrahimi@ki.se
Source
Breast Cancer Res Treat. 2013 Jan;137(1):297-305
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - metabolism - mortality
Carcinoma, Ductal, Breast - metabolism - mortality
Carcinoma, Lobular - metabolism - mortality
Female
Humans
Middle Aged
Organ Size
Placenta - pathology
Pregnancy
Premenopause
Proportional Hazards Models
Prospective Studies
Receptors, Estrogen - metabolism
Receptors, Progesterone - metabolism
Risk
Sweden - epidemiology
Abstract
Placental weight may be regarded as an indirect marker of hormone exposures during pregnancy. There is epidemiological evidence that breast cancer mortality in premenopausal women increases with placental weight in the most recent pregnancy. We investigated if this association differs by tumor characteristics, including expression of estrogen and progesterone receptors. In a Swedish population-based cohort, we followed 1,067 women with premenopausal breast cancer diagnosed from 1992 to 2006. Using Cox regression models, we estimated hazard ratios for the association between placental weight and risk of premenopausal breast cancer mortality. In stratified analyses, we estimated mortality risks in subjects with different tumor stages, estrogen receptor (ER) or progesterone receptor (PR) status. Compared with women with placental weight less than 600 g, women with a placental weight between 600 and 699 g were at a 50 % increased risk of mortality, however, not significant change in risk was observed for women with placental weight = 700 g. Mortality risks associated with higher placental weight were more pronounced among ER(-) and PR(-) breast cancer tumors, where both a placental weight 600-699 g and = 700 g were associated with a more than doubled mortality risks compared with tumors among women with placental weight less than 600 g. Moreover, stratified analyses for joint receptor status revealed that a consistent increased mortality risk by placental weight was only apparent in women with ER(-)/PR(-) breast cancer. The increased mortality risk in premenopausal breast cancer associated with higher placental weight was most pronounced among ER(-) and PR(-) tumors.
PubMed ID
23149466 View in PubMed
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Predictive relevance of HOXB13 protein expression for tamoxifen benefit in breast cancer.

https://arctichealth.org/en/permalink/ahliterature142010
Source
Breast Cancer Res. 2010;12(4):R53
Publication Type
Article
Date
2010
Author
Piiha-Lotta Jerevall
Agneta Jansson
Tommy Fornander
Lambert Skoog
Bo Nordenskjöld
Olle Stål
Author Affiliation
Department of Clinical and Experimental Medicine, Division of Oncology, Faculty of Health Sciences, Linköping University, SE-58185 Linköping, Sweden. piiha-lotta.jerevall@liu.se
Source
Breast Cancer Res. 2010;12(4):R53
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Antineoplastic Agents, Hormonal - therapeutic use
Blotting, Western
Breast Neoplasms - drug therapy - metabolism - pathology
Cell Line, Tumor
Chemotherapy, Adjuvant
Chi-Square Distribution
Female
Homeodomain Proteins - biosynthesis - genetics
Humans
Immunohistochemistry
Kaplan-Meier Estimate
Middle Aged
Postmenopause
Predictive value of tests
Prognosis
Randomized Controlled Trials as Topic
Sweden
Tamoxifen - therapeutic use
Tissue Array Analysis
Treatment Outcome
Abstract
The HOXB13:IL17BR index has been identified to predict clinical outcome in the setting of adjuvant tamoxifen monotherapy of breast cancer. Further studies have shown that HOXB13 in particular can indicate benefit of prolonged tamoxifen treatment. Patients with high-expressing tumors did not benefit from prolonged treatment, suggesting that HOXB13 might be involved in tamoxifen resistance. No studies have been made regarding the HOXB13 protein levels in breast cancer. The aim of our study was to investigate whether tamoxifen benefit can be correlated to different levels of HOXB13 protein expression.
We used immunohistochemistry to analyze protein levels of HOXB13 in tumor samples from 912 postmenopausal node-negative breast cancer patients randomized to adjuvant tamoxifen therapy or no endocrine treatment.
Tamoxifen-treated patients with estrogen receptor-positive tumors expressing none or low levels of HOXB13 had a clear benefit from tamoxifen in terms of longer distant recurrence-free survival (DRFS) (hazard ratio = 0.38, 95% confidence interval = 0.23 to 0.60, P = 0.000048). However, for patients with a high or intermediate HOXB13 tumor expression, tamoxifen did not prolong the DRFS compared with the untreated patients (hazard ratio = 0.88, 95% confidence interval = 0.47 to 1.65, P = 0.69). Interaction between HOXB13 expression and benefit from tamoxifen was statistically significant for DRFS (P = 0.035). No prognostic value could be ascribed to HOXB13 among systemically untreated patients.
A high HOXB13 expression was associated with decreased benefit from tamoxifen, which indicates that HOXB13 protein level may be used as a predictive marker for tamoxifen treatment.
Notes
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PubMed ID
20649975 View in PubMed
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11 records – page 1 of 2.