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BMC Cancer. 2012; 12: 216.
Published online Jun 6, 2012. doi:  10.1186/1471-2407-12-216
PMCID: PMC3433340
Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study
Matteo Clavarezza,corresponding author1,16 Giorgio Mustacchi,2 Andrea Casadei Gardini,3 Lucia Del Mastro,4 Andrea De Matteis,5 Ferdinando Riccardi,6 Vincenzo Adamo,7 Enrico Aitini,8 Domenico Amoroso,9 Paolo Marchetti,10 Stefania Gori,11 Francesco Carrozza,12 Evaristo Maiello,13 Francesco Giotta,14 Davide Dondi,15 and Marco Venturini1
1Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
2Ospedale Civile, Centro Oncologico, Trieste, Italy
3IRST, Meldola, Forlì, Italy
4IRRCS A.O.U. San Martino IST, Genoa, Italy
5Istituto Nazionale Tumori, Naples, Italy
6AORN Cardarelli, Naples, Italy
7A.O. Policlinico G. Martino, Messina, Italy
8A.O. Carlo Poma, Mantova, Italy
9Ospedale Unico Versilia, Lido di Camaiore, Lucca, Italy
10A.O. S. Andrea, Rome, Italy
11Ospedale Santa Maria della Misericordia, Perugia, Italy
12Ospedale A. Cardarelli, Campobasso, Italy
13IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
14IRCCS Oncologico, Bari, Italy
15Sanofi-Aventis, Milan, Italy
16Oncology Department, Ospedale Sacro Cuore Don Calabria Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
corresponding authorCorresponding author.
Matteo Clavarezza: matclava78/at/libero.it; Giorgio Mustacchi: giorgio.mustacchi/at/ass1.sanita.fvg.it; Andrea Casadei Gardini: casadeigardini/at/gmail.com; Lucia Del Mastro: lucia.delmastro/at/istge.it; Andrea De Matteis: DEMATTEISANDREA/at/libero.it; Ferdinando Riccardi: nando.riccardi/at/alice.it; Vincenzo Adamo: vadamo/at/unime.it; Enrico Aitini: enrico.aitini/at/hotmail.com; Domenico Amoroso: d.amoroso/at/usl12.toscana.it; Paolo Marchetti: paolo.marchetti/at/ospedalesantandrea.it; Stefania Gori: stefania.gori/at/tin.it; Francesco Carrozza: francar/at/tin.it; Evaristo Maiello: e.maiello/at/operapadrepio.it; Francesco Giotta: francescogiotta/at/libero.it; Davide Dondi: davide.dondi/at/sanofi-aventis.com; Marco Venturini: marco.venturini/at/sacrocuore.it
Received November 28, 2011; Accepted June 6, 2012.
Abstract
Background
International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters.
Methods
An observational study (NEMESI) was conducted in 63 Italian oncology centres in patients with early breast cancer. Age, performance status, concomitant disease, menopausal status, histology, tumor dimension (pT), axillary lymph node status (pN), grading (G), estrogen and progesterone receptor (ER and PgR), proliferative index (ki67 or MIB-1), human epidermal growth factor receptor 2 (HER2) and type of adjuvant treatment were recorded. The primary objective of the study was to define parameters influencing the decision to prescribe adjuvant chemotherapy and the type of chemotherapy.
Results
Data for 1894 patients were available. 69.0% postmenopausal, 67.0% pT1, 22.3% pTmic/pT1a/pT1b, 61.0% pN0, 48.7% luminal A, 18.1% luminal B, 16.1% HER2 positive, 8.7% triple negative, 8.4% unknown. 57.8% received adjuvant chemotherapy: 38.1% of luminal A, 67.3% luminal B, 88.2% HER2-positive, 97.6% triple negative. Regimens administered: 9.1% CMF-like, 48.8% anthracyclines, 38.4% anthracyclines plus taxanes, 3.7% taxanes alone. Increasing pT/pN and, marginally, HER2-positive were associated with the prescription of anthracyclines plus taxanes. Suboptimal schedules (CMF-like or AC/EC or FEC-75) were prescribed in 37.3% receiving chemotherapy, even in HER2-positive and triple negative disease (36.5% and 34.0%, respectively).
Conclusions
This study showed an overprescription of adjuvant chemotherapy for early breast cancer, particularly referred to luminal A. pT, pN and, marginally, HER2 were the principal determinants for the choice of chemotherapy type. Suboptimal chemotherapy regimens were adopted in at least one third of HER2-positve and triple negative.
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