Leukocyte nadir as a predictive factor for efficacy of adjuvant chemotherapy in breast cancer. Results from the prospective trial SBG 2000–1

Paula Poikonen-Saksela*, Henrik Lindman, Asgerdur Sverrisdottir, Per Edlund, Kenneth Villman, Lena Tennvall Nittby, Søren Cold, Troels Bechmann, Lars Stenbygaard, Bent Ejlertsen, Michael Andersson, Carl Blomqvist, Jonas Bergh, Johan Ahlgren

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Abstrakt

Background: Retrospective studies have suggested that chemotherapy-induced leukopenia is associated with improved recurrence-free or overall survival. The SBG 2000–1 trial was designed to verify the favorable prognosis associated with chemotherapy-induced leukopenia in early breast cancer. Patients not experiencing chemotherapy-induced leukopenia were randomized into standard dosed or individually escalated chemotherapy doses based on the grade of leukopenia after a first standard dose. Patients and methods: 1452 women in Sweden and Denmark with operable node-positive or high-risk node-negative breast cancer aged 18–60 years were recruited to participate in this trial. Participants received a first FEC cycle at standard doses (600/60/600 mg/m2). Patients (n = 1052) with nadir leukopenia grade 0–2 after the first cycle were randomized between either 6 standard FEC or 6 tailored FEC courses with doses of epirubicin and cyclophosphamide escalated during courses 2 and 3 and thereafter aimed at achieving grade 3 leukopenia. Patients with nadir leukopenia grade 3–4 after the first course continued treatment with standard FEC. Results of the randomized comparison has been published previously. The present study focuses on chemotherapy-induced leukopenia as a covariable with outcome in randomized and non-randomized patients. The prognostic value of leukopenia after course 3, was studied in a Cox model adjusted for cumulative doses of epirubicin and cyclophosphamide. The association of chemotherapy-induced leukopenia with prognosis was a preplanned secondary endpoint for this trial. Results: The eight-year distant disease-free survival was 73%, 77%, 78% and 83% for patients with leucocyte nadir grade 0, 1, 2 and 3–4, respectively. Higher degree of leukopenia was highly significantly associated to improved distant disease-free survival (HR 0.84, 95% CI 0.74–0.96, p =.008) and overall survival (HR 0.87 (0.76–0.99, p =.032). Conclusion: This prospective study confirms that chemotherapy-induced leukopenia is a covariable with outcome in primary breast cancer, even after adjustment for chemotherapy doses.

OriginalsprogEngelsk
TidsskriftActa Oncologica
Vol/bind59
Udgave nummer7
Sider (fra-til)825-832
ISSN0284-186X
DOI
StatusUdgivet - jul. 2020

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  • Citationsformater

    Poikonen-Saksela, P., Lindman, H., Sverrisdottir, A., Edlund, P., Villman, K., Tennvall Nittby, L., Cold, S., Bechmann, T., Stenbygaard, L., Ejlertsen, B., Andersson, M., Blomqvist, C., Bergh, J., & Ahlgren, J. (2020). Leukocyte nadir as a predictive factor for efficacy of adjuvant chemotherapy in breast cancer. Results from the prospective trial SBG 2000–1. Acta Oncologica, 59(7), 825-832. https://doi.org/10.1080/0284186X.2020.1757149