Originally published as JCO Early Release 10.1200/JCO.2008.17.9705 on October 27 2008

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Chemotherapy Use for Hormone Receptor–Positive, Lymph Node–Negative Breast Cancer

Michael J. Hassett, Melissa E. Hughes, Joyce C. Niland, Stephen B. Edge, Richard L. Theriault, Yu-Ning Wong, John Wilson, W. Bradford Carter, Douglas W. Blayney, Jane C. Weeks

From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Information Sciences, City of Hope National Medical Center, Duarte, CA; Department of Breast and Soft Tissue Surgery, Roswell Park Cancer Institute, Buffalo, NY; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Fox Chase Cancer Center, Philadelphia, PA; Ohio State University, Columbus, OH; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; and University of Michigan Cancer Center, Ann Arbor, MI

Corresponding author: Michael J. Hassett, MD, MPH, Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115; e-mail: michael_hassett{at}dfci.harvard.edu

Purpose To describe the frequency of chemotherapy use for hormone receptor (HR)–positive, lymph node (LN)–negative breast cancer from 1997 to 2004 at eight National Comprehensive Cancer Network institutions, to explore whether chemotherapy use varied over time and between institutions, and to identify factors associated with the decision to forego chemotherapy.

Patients and Methods Among women younger than age 70 years with HR-positive, LN-negative breast cancer measuring more than 1 cm, we analyzed the frequency of chemotherapy use on a yearly basis. A multivariable logistic regression model assessed the relationship between receipt of chemotherapy and year of diagnosis, institution, tumor features, and patient characteristics. Interaction terms were added to the model, and stratified analyses were conducted to further explore the determinants of chemotherapy use.

Results Fifty-five percent of 3,190 women received chemotherapy. Chemotherapy use was less common for patients with 1.1- to 2-cm tumors than for patients tumors greater 2 cm (47% v 87%, respectively; P < .01) and for women age 60 to 69 years versus women younger than age 50 years (24% v 76%, respectively; P < .01). On multivariable analysis, predictors independently associated with receiving chemotherapy included larger tumor size, higher grade, human epidermal growth factor receptor 2 overexpression, younger age, and institution (P < .01 for all). Institutions exhibited dramatically different rates of chemotherapy use (from 46% to 65%) and patterns of change in chemotherapy use over time (from a 79% relative increase to a 22% relative decrease).

Conclusion Although institutions seemed to agree that not all women with HR-positive, LN-negative breast cancer need chemotherapy, there did not seem to be consensus regarding which women should get chemotherapy. Only prospective randomized controlled trials will conclusively establish which subtypes of HR-positive, LN-negative breast cancer benefit from chemotherapy.

published online ahead of print at www.jco.org on October 27, 2008

Supported in part by Grant No. P50 CA89393 from the National Cancer Institute to Dana-Farber Cancer Institute and by the National Comprehensive Cancer Network. M.J.H. received salary support from Grant No. R25 CA092203 and from an American Society of Clinical Oncology Career Development Award.

Presented at the American Society of Clinical Oncology 2007 Breast Cancer Symposium, September 7-8, 2007, San Francisco, CA.

The sponsors had no direct influence on the design of the study, analysis of the data, interpretation of the results, or writing of the article.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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