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Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit

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Abstract

Background

Invasive lobular carcinomas (ILCs) represent approximately 10% of all breast cancers. Despite this high frequency, benefit of adjuvant chemotherapy (CT) is still unclear.

Methods

Our objective was to investigate the impact of CT on survival in ILC. Patients were retrospectively identified from a cohort of 23,319 patients who underwent primary surgery in 15 French centers between 1990 and 2014. Only ILC, hormone-positive, human epidermal growth factor 2 (HER2)-negative patients who received adjuvant endocrine therapy (ET) were included. End-points were disease-free survival (DFS) and overall survival (OS). A propensity score for receiving CT, aiming to compensate for baseline characteristics, was used.

Results

Of a total of 2318 patients with ILC, 1485 patients (64%) received ET alone and 823 (36%) received ET + CT. We observed a beneficial effect of addition of CT to ET on DFS and OS in multivariate Cox model (HR = 0.61, 95% confidence interval, CI [0.41–0.90]; p = 0.01 and 0.52, 95% CI [0.31–0.87]; p = 0.01, respectively). This effect was even more pronounced when propensity score matching was used. Regarding subgroup analysis, low-risk patients without CT did not have significant differences in DFS or OS compared to low-risk patients with CT.

Conclusion

ILC patients could derive significant DFS and OS benefits from CT, especially for high-risk patients.

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Abbreviations

CI:

Confidence interval

CT:

Adjuvant chemotherapy

DFS:

Disease-free survival

EC:

Endocrine therapy

HER2:

Human epidermal growth factor 2

HR:

Hazard ratio

IDC:

Invasive duct carcinoma of no special type

IHC:

Immunohistochemistry

ILC:

Invasive lobular carcinoma

LVI:

Lymphovascular invasion

OR:

Odds ratio

OS:

Overall survival

SBR:

Scarff, Bloom, and Richardson

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Funding

This academic work did not receive financial support from any funding source.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France

    Alexandre de Nonneville & Anthony Gonçalves

  2. Department of Surgical Oncology, Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France

    Camille Jauffret, Monique Cohen, Eric Lambaudie & Gilles Houvenaeghel

  3. Institut René Gauducheau, Site hospitalier Nord, St Herblain, France

    Jean-Marc Classe

  4. Institut Curie, 26 rue d’Ulm 75248, Paris, France

    Fabien Reyal

  5. Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France

    Chafika Mazouni

  6. Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France

    Marie-Pierre Chauvet

  7. Centre Léon Bérard, 28 rue Laennec, Lyon, France

    Nicolas Chopin

  8. Centre Val d’Aurelle, Montpellier, France

    Pierre-Emmanuel Colombo

  9. Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France

    Eva Jouve

  10. Hôpital Tenon, 4 rue de la Chine, Paris, France

    Emile Darai

  11. Centre René Huguenin, 35 rue Dailly, Saint Cloud, France

    Roman Rouzier

  12. Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France

    Charles Coutant

  13. Centre Jean Perrin, 58 rue Montalembert, Clermont-Ferrand, France

    Pierre Gimbergues

  14. Chemin de Clavary, Hôpital de Grasse, Grasse, France

    Anne-Sophie Azuar

  15. Institut Bergonié, 229 Cours de l’Argonne, Bordeaux, France

    Christine Tunon de Lara

Authors
  1. Alexandre de Nonneville
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  2. Camille Jauffret
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  12. Emile Darai
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  16. Anne-Sophie Azuar
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  19. Gilles Houvenaeghel
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Contributions

AN, CJ, AG, and GH contributed to literature search, figures, study design, data analysis, data interpretation, and writing. All authors have participated in the data collection. All authors have critically reviewed the final version of the manuscript and approved its content. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Conceptualization AN, CJ, AG, GH. Data curation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Formal analysis AN, CJ, AG, GH. Investigation AN, CJ, AG, GH. Methodology AN, CJ, AG, GH. Project administration AN. Supervision AG, GH. Validation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Visualization AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Writing AN, CJ, AG, GH. Review and editing AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH.

Corresponding author

Correspondence to Alexandre de Nonneville.

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Authors have nothing to disclose.

Ethical Approval

All procedures performed in this study involving human participants were done in accordance with the French Ethical Standards and with the 2008 Helsinki Declaration. As this was a retrospective non-interventional study, no formal personal consent was required.

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Supplementary Fig. 1 Description of the propensity score matching.

Supplementary material 1 (TIF 3948 KB)

Supplementary Fig. 2 Kaplan–Meier estimates of disease-free and overall survival respectively among low- and high-risk patients treated or untreated by chemotherapy. CT adjuvant chemotherapy.

Supplementary material 2 (TIF 2103 KB)

Supplementary material 3 (DOCX 30 KB)

Supplementary material 4 (DOCX 32 KB)

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de Nonneville, A., Jauffret, C., Gonçalves, A. et al. Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit. Breast Cancer Res Treat 175, 379–387 (2019). https://doi.org/10.1007/s10549-019-05160-9

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