The Effects of Tamoxifen and Chemotherapy after Surgery on the Recurrence and Survival of Breast Cancer Patients with Positive Hormone Receptor: A Meta-Analysis
Abstract
Background: Breast cancer is the most common type of cancer suffered by women in the world. The combination of tamoxifen and chemotherapy significantly reduces the risk of recurrence and mortality in breast cancer patients. This study aimed to analyze how effective the combination of tamoxifen and chemotherapy after surgery to reduce the risk of recurrence and mortality in breast cancer patients with positive hormone receptor.
Subjects and Method: This study used systematic review and meta-analysis. The researcher collected articles from the Pubmed journal database. The subjects of the study were women with breast cancer after surgery. The dependent variable was recurrence and survival (mortality). The independent variables were tamoxifen and chemotherapy. Data were analyzed based on the fixed and random effects model using RevMan 5 software.
Results: There were 3 articles with 3,761 women who were involved in the analysis process. The combination of tamoxifen and chemotherapy could reduce the risk of recurrence in women with positive hormone receptor (ER+) breast cancer (HR=0.68; 95%CI=0.58 to 0.80; p=0.001). The combination of tamoxifen and chemotherapy showed weak and non-significant decreasing trend in reducing the risk of mortality in women with ER+breast cancer (HR=0.87; 95%CI=0.73 to 1.03; p= 0.11).
Conclusion: The combination of tamoxifen and chemotherapy in women with ER+ breast cancer is effective in reducing the risk of recurrence. However, it does not increase survival.
Keywords: tamoxifen, chemotherapy, breast cancer.
Correspondence:
Trisakti Halimah Delimasari. Program Studi Ilmu Kesehatan Kesehatan, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: trisaktihd1994@gmail.com. Mobile: +6285 293 994 629.
Indonesian Journal of Medicine (2019), 4(4): 346-353
https://doi.org/10.26911/theijmed.2019.04.04.07
References
Akram M (2012). Breast cancer management: past, present and evolving. Indian J Cancer, 49: 277–282. https://doi.org/10.4103/0019509X.104486.
Awan A, Esfahani K (2018). Endocrine therapy for breast cancer in the primary care setting. Curr Oncol, 25(4): 285–291. https://doi.org/10.3747/co.25.4139.
Bramwell VHC, Pritchard KI, Tu D, Tonkin K, Vachhrajani H, Vandenberg TA, Shepherd L (2010). A randomized placebo-controlled study of tamoxifen after adjuvant chemotherapy in premenopausal women with early breast cancer. Annals of Oncology, 21: 283–290. https://doi.org/10.1093/annonce/mdp326.
Bray F, Ferlay J, Soerjomataram I (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin, 68: 394–424. https://doi.org/10.3322/caac.21-492.
Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon K (2014). Adjuvant endocrine therapy for women with hormone receptorpositive breast cancer: American society of clinical oncology clinical practice guideline focused update. J Clin Oncol Off, 32: 2255–2269. https://doi.org/10.1200/JCO.2013.54.2258.
Davies C, Godwin J, Gray R (2011). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomized trials. Lancet, 378(9793): 771–784. https://doi.org/10.1016/S0140-6736-(11)609938.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2012). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of longterm outcome among 100,000 women in 123 randomised trials. Lancet, 379(9814): 432–444. doi: 10.1016/S0140673 6(11)61 625-5.
Fisher B, Anderson S, Tan-Chiu E, Wolmark N, Wickerham DL, Fisher ER, Dimitrov N (2001). Tamoxifen and chemotherapy for axillary nodenegative, estrogen receptornegative breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-23. J Clin Oncol, 19(4): 931–942. https://doi.org/DOI: 10.1200/JCO.2001.19.4.931.
Hutchins LF, Green SJ, Ravdin PM, Lew D, Martino S, Abeloff M (2015). Randomized, controlled trial of cyclophosphamide, methotrexate, and fluorouracil versus cyclophosphamide, doxorubicin, and fluorouracil with and without tamoxifen for high-risk, nodenegative breast cancer: treatment results of intergroup protocol INT-0102. J Clin Oncol, 23(33): 8313–8321. https://doi.org/10.1200/JCO.205.08.071.
International Agency for Research on cancer (IARC) (2018). Number of incidence, mortality, prevalence and new cases on breast cancer 2018. Retrieved from http://gco.iarc.fr.
International breast cancer studi group (2015). tamoxifen after adjuvant chemotherapy for premenopausal women with lymph node–positive breast cancer: International breast cancer study group trial. J Clin Oncol, 24(9): 13-93. https://doi.org/10.1200/JCO.2005.03.0783.
Jankowitz RC, Davidson N (2013). Adjuvant endocrine therapy for breast cancer: how long is long enough. J Clin Oncol, 27(12): 1210–11224. https://www.ncbi.nlm.nih.gov/pubmed/24624537.
Jankowitz RC, Davidson N (2013). Adjuvant endocrine therapy for breast cancer: how long is long enough? J Clin Oncol, 27(12): 1210–1216.
Listyawardhani Y, Mudigdo A, Adriani RB (2018). Risk factors of breast cancer in women at Dr. Moewardi Hospital, Surakarta, Central Java. JEPH, 3(2): 118–127. https://doi.org/10.26911/jepublichealth.2018.03.02.02.
Morales L, Canney P, Dyczka J, Rutgers E, Coleman R, Cufer T, Hospital WP. (2006). Postoperative adjuvant chemotherapy followed by adjuvant tamoxifen versus nil for patients with operable breast cancer: A randomised phase III trial of the European organisation for research and treatment of cancer breast group. EJC, 43: 331-340. https://doi.org/10.1016/j.ejca.2006.10.009.
Rubin G (2015). The expanding role of primary care in cancer control. Lancet Oncol, 6(12): 1231–1272. https://doi.org/10.1016/S1470204515)00253.
Ruihua T, Yongqiang L, Zongzhu Z (2017). The study of correlation between neoadjuvant chemotherapy and the expression of VEGF, HIF-1α and MVD in breast cancer. Biomedical Research, (Special Issue): 537–541. ISSN: 0976-1 683.
Tang Y, Wang Y, Kiani MF, Wang B (2016). Classification, treatment strategy and associated drug resistance in breast cancer. Clin Breast Can, 1 (16). https://doi.org/10.1016/j.clbc.2016.05.012.
Wiraswesty I, Respati SH, Sulistyowati S, Priyanto H (2016). The effect of neoadjuvant chemotherapy on HIF-1α expression in cervical uterine cancer. IJM, 3 (2): 119–124. https://doi.org/10.26911/theijmed.2018.03.02.08.
Yu Z, Guo X, Jiang Y, Teng L, Luo J. (2017). Adjuvant endocrine monotherapy for postmenopausal early breast cancer patients with hormone-receptor positive: a systemic review and network meta-analysis. JBC. https://doi.org/10.1007/s12282017-0794-8
