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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
Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Dept Oncol, Jönköping, Sweden; Lund Univ, Sweden.
Lund Univ, Sweden.
Lund Univ, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
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2019 (Engelska)Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 110, s. 53-61Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
ELSEVIER SCI LTD , 2019. Vol. 110, s. 53-61
Nyckelord [en]
Adjuvant therapy; Tamoxifen; Premenopausal; Long-term follow-up
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
URN: urn:nbn:se:liu:diva-155552DOI: 10.1016/j.ejca.2018.12.034ISI: 000460123000009PubMedID: 30769227OAI: oai:DiVA.org:liu-155552DiVA, id: diva2:1299388
Anmärkning

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

Tillgänglig från: 2019-03-26 Skapad: 2019-03-26 Senast uppdaterad: 2019-06-04

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Ekholm, MariaNordenskjöld, BoStål, Olle
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Institutionen för klinisk och experimentell medicinMedicinska fakultetenAvdelningen för Kirurgi, Ortopedi och OnkologiOnkologiska kliniken US
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