Profile, treatment patterns, and influencing factors of anthracycline use in breast cancer patients in China: A nation-wide multicenter study

Fengzhu Guo; Zongbi Yi; Wenna Wang; Yiqun Han; Pei Yu; Su Zhang; Quchang Ouyang; Min Yan; Xiaojia Wang; Xichun Hu; Zefei Jiang; Tao Huang; Zhongsheng Tong; Shusen Wang; Yongmei Yin; Hui Li; Runxiang Yang; Huawei Yang; Yuee Teng; Tao Sun; Li Cai; Hongyuan Li; Xi Chen; Jianjun He; Xinlan Liu; Shune Yang; Jinhu Fan; Youlin Qiao; Jiayu Wang; Binghe Xu

doi:10.1002/cam4.4215

Profile, treatment patterns, and influencing factors of anthracycline use in breast cancer patients in China: A nation-wide multicenter study

Cancer Med. 2021 Oct;10(19):6744-6761. doi: 10.1002/cam4.4215. Epub 2021 Sep 2.

Authors

Fengzhu Guo^{1

2}, Zongbi Yi¹, Wenna Wang¹, Yiqun Han¹, Pei Yu³, Su Zhang³, Quchang Ouyang⁴, Min Yan⁵, Xiaojia Wang⁶, Xichun Hu⁷, Zefei Jiang⁸, Tao Huang⁹, Zhongsheng Tong¹⁰, Shusen Wang¹¹, Yongmei Yin¹², Hui Li¹³, Runxiang Yang¹⁴, Huawei Yang¹⁵, Yuee Teng¹⁶, Tao Sun¹⁷, Li Cai¹⁸, Hongyuan Li¹⁹, Xi Chen²⁰, Jianjun He²¹, Xinlan Liu²², Shune Yang²³, Jinhu Fan³, Youlin Qiao³, Jiayu Wang¹, Binghe Xu¹

Affiliations

¹ Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Breast Cancer Medical Oncology, Hunan Cancer Hospital, Changsha, China.
⁵ Department of Breast Disease, Henan Breast Cancer Center, The affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
⁶ Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
⁷ Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁸ Department of Breast Cancer, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China.
⁹ Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
¹¹ Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹² Department of Medical Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹³ Department of Breast Surgery, Sichuan Province Tumor Hospital, Chengdu, Sichuan, China.
¹⁴ Department of Medical Oncology, Yunnan Cancer Hospital, Kunming Medical University, Kunming, China.
¹⁵ Department of Breast Surgery, Cancer Hospital, Guangxi Medical University, Guangxi, China.
¹⁶ Departments of Medical Oncology and Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China.
¹⁷ Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Key Laboratory of Liaoning Breast Cancer Research, Shenyang, China.
¹⁸ The 4th Department of Internal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁹ Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
²⁰ Department of Medicine Oncology, 900 Hospital of the Joint Logistics Team, Fuzhou, China.
²¹ Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
²² Department of Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
²³ Department of Breast Cancer and Lymphoma, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China.

Abstract

Background: Anthracycline-based chemotherapy (ABC) is one of the standard therapies against breast cancer. However, few guidelines are currently available to optimize the use of ABC. Therefore, the present analysis aimed at determining the profile and treatment patterns of ABC and the association of clinicopathological characteristics with ABC selection.

Methods: We retrospectively analyzed the data of a nation-wide multicenter epidemiological study, which collected the medical records of breast cancer patients receiving chemotherapy in different settings from seven geographic regions in China (NCT03047889).

Results: In total, 3393 patients were included, with 2917 treated with ABC. Among them, 553 (89.8%), 2165 (81.7%), and 814 (25.7%) were subjected to ABC as neoadjuvant, adjuvant, and advanced chemotherapy, respectively. The most frequently used regimens were anthracycline-taxane-based combinations for neo- and adjuvant chemotherapy, along with taxanes and oral fluorouracils for the palliative stages. In the overall cohort, patients aged < 40 or 40-65 (p < 0.001), in premenopause (p < 0.001), without comorbidities (p = 0.016), with invasive ductal carcinoma (p= 0.001), high lymph node involvement (p < 0.001), in the pTNM stage II, III, or IV versus stage I (p < 0.001), subjected to mastectomy (p < 0.001) or subjected to sentinel lymph node biopsy combined with axillary lymph node dissection (p = 0.044), or with a decreased disease-free survival (p < 0.001) were more likely to be recommended to ABC.

Conclusion: Taken together, ABC remained the mainstay of breast cancer treatment, especially in neo and adjuvant therapy. ABC was mainly used as a combination therapy, and the correlation between influencing factors and ABC choice varied during different settings, indicating the preference and different perspectives of medication considered by medical oncologists regarding the use ABC in China.

Keywords: anthracycline; breast cancer; chemotherapy; epidemiological study; nation-wide.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Anthracyclines / pharmacology
Anthracyclines / therapeutic use*
Breast Neoplasms / drug therapy*
China
Female
Humans
Middle Aged
Retrospective Studies

Substances

Anthracyclines

Associated data

ClinicalTrials.gov/NCT03047889

Grants and funding

CH-BC-045/the Investigator-initiated program of the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College