New study and delayed chemo waiting for on oncotype

Srh242 · March 2014

I delayed chemo for about 60 days waiting for a repeat of the oncotype test. There is a new study saying that a delay of equal or more than 61 days was detrimental. My doctor last year told me that 60 days was ok. I am er, pr positive . Can anyone help me understand this study and why they have changed? Thanks

SpecialK · March 2014

Can you link the specific study you are referring to?

Hortense · March 2014

Well, if it is detrimental, then I was detrimentalized - if that's a word - as I waited a long time too.

SpecialK · March 2014

hortense - I am on that list with you! I also just read that starting Herceptin late is a problem as well - so I am double detrimentalized.

srh - is this the info you were referring to:

http://www.breastcancer.org/research-news/20140220-4

wrenn · March 2014

i had chemo about 90 days after surgery.

Racy · March 2014

wow, very interesting study. I started chemo about 11 weeks after initial surgery as I had an onc (since fired) who did not return phone calls!

doxie · March 2014

I too started chemo late, right at 90 days. I was not released to the MO until cleared by the BS after two surgeries. Then when my MO ordered the Oncotype, the results were delayed three weeks due to a shipping error at the local hospital.

The clinic protocol needs to change so that the BS and MO work together when pathology results are available. I know some clinics/hospitals already have that model. My BS knew I needed the Oncotype as soon as he saw my results, but they weren't ordered until after I say the MO.

Srh242 · March 2014

Yes Special K thats the study. I dont know how to read it since it sayson some parts that delaying didnt influenced outcome on hormone positive and on other parts it says it did. Have to ask my onco.

Srh242 · March 2014

I dont know if it matters or not for hormone positive cancers.there are different things I found on this study.

Srh242 · March 2014

HOMEASCO-SEPCOURSE CATALOGSLIDE LIBRARYCERTIFICATESTRAINING PROGRAMSMEETING LIBRARYBOOKSTORE You are here Home » Meeting Library » Abstracts » 2013 ASCO Annual Meeting Impact of delaying initiation of adjuvant chemotherapy in breast cancer patients. Subcategory: Cytotoxic Chemotherapy Category: Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy Meeting: 2013 ASCO Annual Meeting Session Type and Session Title: Poster Discussion Session, Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy Abstract Number: 1022 Citation: J Clin Oncol 31, 2013 (suppl; abstr 1022) Author(s): Debora De Melo Gagliato, Ana M. Gonzalez-Angulo, Xiudong Lei, Sharon Hermes Giordano, Richard L. Theriault, Vicente Valero, Gabriel N. Hortobagyi, Mariana Chavez-Mac Gregor; The University of Texas MD Anderson Cancer Center, Houston, TX; Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^). Abstract Disclosures 2013 ASCO Annual Meeting Proceedings Errata Abstract: Background: The survival benefit of adjuvant chemotherapy in breast cancer is well established. However, the optimal timing to initiation of chemotherapy after definitive surgery is unknown. We evaluated the association between time to initiation of chemotherapy and survival outcomes according to breast cancer subtype and stage at diagnosis. Methods: Women diagnosed with stage I–III breast cancer between 1997-2011 who received adjuvant chemotherapy at our institution were included. Patients were categorized according to time from definitive surgery to adjuvant chemotherapy into one of three groups: ≤ 30 days, 31–60 days and more than 60 days. Descriptive statistics, Kaplan-Meier statistics and Cox proportional hazards models were used. Results: Among the 6,827 patients included, the 5-year Overall Survival (OS), Relapse-Free Survival (RFS) and Distant Relapse-Free Survival (DRFS) estimates were similar for the different time-to-chemotherapy categories. Among patients with stage I, there was no association between outcome and time to initiation of chemotherapy. Patients with stage II disease experienced an 18% and 22% increase in risk of RFS (HR 1.18; p=0.038) and DRFS (HR 1.22; p=0.02), when systemic treatment was started 60 days from surgery. Patients with stage III disease that started adjuvant chemotherapy 60 days after surgery had a 70% increase in the risk of death (HR 1.7; p=0.002), a 32% increase risk of relapse (HR 1.32; p=0.046) and a 34% increase risk of distant relapse (HR 1.34; p=0.044). Time to chemotherapy did not have a significant effect on outcome among Hormone Receptor (HR)-positive patients. Patients with triple negative (TNBC) and HER2-positive tumors treated with trastuzumab who started chemotherapy 60 days after surgery had lower 5 year-OS estimates (HR 1.52; p=0.016 and HR 2.62; p=0.005, respectively). Conclusions: Time to chemotherapy did not influence survival outcomes in the overall population. However, patients with stage III, TNBC and HER2-positive tumors treated with trastuzumab, experienced worse outcomes when chemotherapy was delayed. Among patients with tumors with aggressive biology and more advanced stages at diagnosis, early initiation of therapy should be favored. Share on print Share on email Share on twitter Share on facebook Share on linkedin ASSOCIATED PRESENTATION Meeting: 2013 ASCO Annual Meeting Presenter: Debora De Melo Gagliato View Presentation PRESENTATION SLIDES View Slides

SpecialK · March 2014

srh - I think it is important to note that this study was an institution based observational study - they just tracked their patients, but the study included no manipulation of treatment. The patient cohort included patients with a variety of hormonal receptor and Her2 status, and included patients from stage 1-3. This is a broad spectrum - it is not surprising that the Her2+ and triple negative patient populations, and the higher stage patients, had worse outcomes with a chemo delay, but there is no real way to know if those individual patients would have had a worse outcome if they had received chemo in the shorter term because some segment of those populations will always have a worse outcome regardless. Also, this study covered a long time period, and some therapies that are currently being used, such as Herceptin, were not given to early stage patients who would have been treated at the time this study commenced. There are also some newer chemotherapeutic agents that were not as commonly used. It looks like they broke out some of that information, but if they tracked the population as a whole this would have skewed the stats going back to the beginning. It would be interesting to see the statistics in a timeline rather than a summary. My take on this study is that if you can get to chemo more quickly that is great, but common sense tells you that also. My delay was caused by five unavoidable surgeries, I started more than 100 days after BMX and I am Her2+, but nothing I could have done to get there faster.

Srh242 · March 2014

Special K , I found a lot of previous studies saying that a delay of 120 days was the cutoff, before doing chemo last year. I too had to wait due to losing a baby and been devastated plus waiting for a second oncotype on the lumpectomy. But this study did said at the end that : time to chemotherapy did not influenced survival in the overall population.

SpecialK · March 2014

srh - I am so sorry about the loss of your baby and a cancer diagnosis on top of that, what a huge amount of stress and heartbreak for you. Try not to worry too much about the results of this study.

Srh242 · March 2014

Thank you Specialk is hard not to look back, but I did lost my mind a little bit after all this process .

SpecialK · March 2014

I know what you mean - this situation is scary enough without wondering if we did the right things to survive. I will always wonder if I should have had radiation, and I will always wonder if estrogen-only hormone replacement therapy after a hyst/ooph was detrimental to me prior to diagnosis. This is the nature of the beast, but we can't change the past, or predict the future, we can only live in the moment we are in. I participated in a research study not long after I finished chemo, but still receiving Herceptin. Its purpose was to teach mindfulness based stress reduction and quantify if it reduced stress hormones by blood and saliva samples. I learned a lot of good techniques for relaxation and focus on the moment. Much of the teaching was based on this book, you and others may find it helpful:

http://www.amazon.com/Full-Catastrophe-Living-Revised-Illness/dp/0345536932/ref=sr_1_1?s=books&ie=UTF8&qid=1393957677&sr=1-1&keywords=full+catastrophe+living

Srh242 · March 2014

thanks for the book link SpecialK!

SpecialK · March 2014

You are welcome - it is an awesome book!

Srh242 · March 2014

Doxie and Wrenn: part of the study sayed that a delayed didn't matter at all for stage 1.

New study and delayed chemo waiting for on oncotype

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