Skip to main content

Advertisement

SpringerLink
Log in

Does time to adjuvant chemotherapy (TTC) affect outcomes in patients with triple-negative breast cancer?

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

A recent study reported that time to adjuvant chemotherapy (TTC) > 30 days was significantly associated with worse OS and DFS in triple-negative breast cancer (TNBC). Earlier studies, however, found that worse outcomes were associated with TTC > 60 days or > 90 days. As the trend for mastectomy with reconstruction continues to rise, TTC of < 30 days is often not feasible due to wound-healing issues in some of these patients. To elucidate the impact of TTC, we sought to evaluate the clinical outcomes associated with TTC in a contemporary cohort treated for TNBC at a single institution.

Methods

A single-institution database was queried to identify nonmetastatic TNBC patients who received adjuvant chemotherapy from 2009 to 2018. TTC was defined as interval between date of surgery and adjuvant chemotherapy start date. Median TTC was used to divide our cohort into four quartiles; ≤ 31, 32–42, 43–56,  and > 56 days. Logrank, Kaplan–Meier, and inverse probability weighting (IPW) tests were used to analyze disease-free (DFS) and overall survival (OS).

Results

The mean TTC of our study cohort (n = 724) was 48 days (median TTC = 42 days). Black race, mastectomy without adjuvant radiation, and mastectomy with immediate reconstruction were associated with delayed TTC (all p-values < 0.01). In multivariate IPW analysis, TTC > 56 (n = 173) days did not impact DFS or OS compared to TTC ≤ 31 (n = 198) days (p = 0.27 and p = 0.21, respectively). Similar results were seen during subgroup analysis for groups identified as higher risk for delayed TTC.

Conclusion

Our results demonstrated that TTC was not significant or significantly associated with DFS or OS in patient receiving chemotherapy for operable TNBC. Our results were reassuring for patients electing mastectomy with immediate reconstruction, who may experience a longer TTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yamamoto Y, Iwase H (2010) Clinicopathological features and treatment strategy for triple-negative breast cancer. Int J Clin Oncol 15:341–351. https://doi.org/10.1007/s10147-010-0106-1

    Article  PubMed  Google Scholar 

  2. Foulkes WD, Smith IE, Reis-Filho JS (2010) Triple-negative breast cancer. N Engl J Med 363:1938–1948. https://doi.org/10.1056/NEJMra1001389

    Article  CAS  PubMed  Google Scholar 

  3. De Melo Gagliato D, Gonzalez-Angulo AM, Lei X et al (2014) Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol 32:735–744. https://doi.org/10.1200/JCO.2013.49.7693

    Article  CAS  Google Scholar 

  4. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH (2016) Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol 2:322–329. https://doi.org/10.1001/jamaoncol.2015.3856

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cold S, Düring M, Ewertz M et al (2005) Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG). Br J Cancer 93:627–632. https://doi.org/10.1038/sj.bjc.6602734

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Colleoni M, Coates AS, Gelber RD et al (2000) Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. J Clin Oncol 18:584–584. https://doi.org/10.1200/jco.2000.18.3.584

    Article  CAS  PubMed  Google Scholar 

  7. Lohrisch C, Paltiel C, Gelmon K et al (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 24:4888–4894. https://doi.org/10.1200/jco.2005.01.6089

    Article  PubMed  Google Scholar 

  8. Jara Sánchez C, Ruiz A, Martín M et al (2006) Influence of timing of initiation of adjuvant chemotherapy over survival in breast cancer: a negative outcome study by the spanish breast cancer research group (GEICAM). Breast Cancer Res Treat 101:215–223. https://doi.org/10.1007/s10549-006-9282-0

    Article  PubMed  Google Scholar 

  9. McLaughlin JM, Anderson RT, Ferketich AK et al (2012) Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer. J Clin Oncol 30:4493–4500. https://doi.org/10.1200/jco.2012.39.7695

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shannon C, Ashley S, Smith IE (2003) Does timing of adjuvant chemotherapy for early breast cancer influence survival? J Clin Oncol 21:3792–3797. https://doi.org/10.1200/JCO.2003.01.073

    Article  CAS  PubMed  Google Scholar 

  11. Hershman DL, Jacobson JS, Wang X et al (2006) Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat 99:313–321. https://doi.org/10.1007/s10549-006-9206-z

    Article  CAS  PubMed  Google Scholar 

  12. Bellon JR, Come SE, Gelman RS et al (2005) Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol 23:1934–1940. https://doi.org/10.1200/JCO.2005.04.032

    Article  PubMed  Google Scholar 

  13. Morante Z, R R, De la Cruz G Impact of the delayed initiation of adjuvant chemotherapy in the outcomes of triple negative breast cancer

  14. Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34:3661–3679. https://doi.org/10.1002/sim.6607

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cole SR, Hernán MA (2008) Constructing inverse probability weights for marginal structural models. Am J Epidemiol 168:656–664. https://doi.org/10.1093/aje/kwn164

    Article  PubMed  PubMed Central  Google Scholar 

  16. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  Google Scholar 

  17. Buzdar AU, Smith TL, Powell KC et al (1982) Effect of timing of initiation of adjuvant chemotherapy on disease-free survival in breast cancer. Breast Cancer Res Treat 2:163–169

    Article  CAS  PubMed  Google Scholar 

  18. Vandergrift JL, Niland JC, Theriault RL et al (2013) Time to adjuvant chemotherapy for breast cancer in national comprehensive cancer network institutions. J Natl Cancer Inst 105:104–112. https://doi.org/10.1093/jnci/djs506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Khan F, Cranmer D, Kachajian J et al (2016) Access to care in vermont: factors linked with time to chemotherapy for women with breast cancer—a retrospective cohort study. J Oncol Pract 12:e848–e857. https://doi.org/10.1200/jop.2016.013409

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Maria K. Pomponio, Luke J. Keele & Julia C. Tchou

  2. Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Luke J. Keele

  3. Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kevin R. Fox, Amy S. Clark, Jennifer M. Matro & Lawrence N. Shulman

  4. Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kevin R. Fox, Amy S. Clark, Jennifer M. Matro, Lawrence N. Shulman & Julia C. Tchou

Authors
  1. Maria K. Pomponio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luke J. Keele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin R. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amy S. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer M. Matro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lawrence N. Shulman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julia C. Tchou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julia C. Tchou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10549_2019_5282_MOESM1_ESM.tif

Supplementary material 1—Kaplan–Meier curves for overall survival (OS) and disease free survival (DFS)according to time to chemotherapy (TTC), in months, for TNBC patients, with a TTC of ≤ 30 days as a reference group (TIFF 929 kb)

Supplementary material 2 (XLSX 10 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pomponio, M.K., Keele, L.J., Fox, K.R. et al. Does time to adjuvant chemotherapy (TTC) affect outcomes in patients with triple-negative breast cancer?. Breast Cancer Res Treat 177, 137–143 (2019). https://doi.org/10.1007/s10549-019-05282-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-019-05282-0

Search

Navigation