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Effects of adjuvant tamoxifen over three decades on breast cancerefree and distant recurrence-free interval among premenopausal women with oestrogen receptor-positive breast cancer randomised in the Swedish SBII:2pre trial
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Dept Oncol, Jönköping, Sweden; Lund Univ, Sweden.
Lund Univ, Sweden.
Lund Univ, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
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2019 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 110, p. 53-61Article in journal (Refereed) Published
Abstract [en]

Aims: The primary aim was to compare 2 years of adjuvant tamoxifen versus no systemic treatment in premenopausal patients with oestrogen receptor (ER) epositive tumours, regarding breast cancerefree interval (BCFi) and distant recurrenceefree interval (D-RFi), with 30 years of follow-up and for specified intervals. Moreover, we aimed to investigate the effects of adjuvant tamoxifen on the incidence of secondary malignancies and survival after distant recurrence. Methods: Premenopausal patients with primary breast cancer were randomised to 2 years of tamoxifen (n=277) or no systemic treatment (n=287), irrespective of ER status. Information regarding events was collected by a review of medical records and from national registers. Results: The median follow-up for all patients without events was 28 years, and only four of the patients alive had a follow-up of amp;lt;20 years. With 30 years of follow-up, tamoxifen prolonged BCFi in the intention-to-treat population (hazard ratio [HR] = 0.76, 95% confidence interval (CI) 0.61-0.94, p = 0.011) compared with no treatment. In patients with ER-positive tumours (n = 362), tamoxifen prolonged BCFi (HR = 0.62, 95% CI 0.47-0.82, p = 0.001) and D-RFi (HR = 0.73, 95% CI 0.54-0.99, p = 0.043). The positive effect on BCFi was significant also for the interval amp;gt; 15-30 years (HR = 0.53, 95% CI 0.28-0.98, p = 0.042). For patients with ER-positive tumours who were diagnosed with distant recurrence (n=165), survival after distant recurrence was shorter among tamoxifen-treated patients (median, 29 months versus 43 months). The incidence of contralateral breast cancer was 42% lower in the tamoxifen group (HR=0.58, 95% CI 0.35-0.96, p=0.035), whereas no differences were observed regarding other secondary malignancies. Conclusions: With three decades of follow-up, 2 years of adjuvant tamoxifen reduced the incidence of breast cancererelated events and distant recurrence, and the carryover effect seems to extend beyond 15 years. Moreover, adjuvant tamoxifen seems to be associated with shorter survival after diagnosis of distant recurrence. (C) 2019 The Authors. Published by Elsevier Ltd.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2019. Vol. 110, p. 53-61
Keywords [en]
Adjuvant therapy; Tamoxifen; Premenopausal; Long-term follow-up
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-155552DOI: 10.1016/j.ejca.2018.12.034ISI: 000460123000009PubMedID: 30769227OAI: oai:DiVA.org:liu-155552DiVA, id: diva2:1299388
Note

Funding Agencies|Futurum-the Academy of Health and Care; Jonkoping County Council; Foundation for Clinical Cancer Research in Jonkoping; FORSS (Medical Research Council of Southeast Sweden); Gunnar Nilsson Cancer Foundation; Mrs. Berta Kamprad Foundation; Anna and Edwin Bergers Foundation; Swedish Cancer and Allergy Foundation; Governmental Funding of Clinical Research within the Swedish National Health Service; Swedish Cancer Society

Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-06-04

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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesDivision of Surgery, Orthopedics and OncologyDepartment of Oncology
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