Adjuvant chemotherapeutic treatment of 1650 patients with early breast cancer in routine care in Germany: data from the prospective TMK cohort study

Steffen Dörfel, Claus-Christoph Steffens, Dirk Meyer, Hans Tesch, Lisa Kruggel, Melanie Frank, Martina Jänicke, Norbert Marschner, TMK-Group (Tumour Registry Breast Cancer), Steffen Dörfel, Claus-Christoph Steffens, Dirk Meyer, Hans Tesch, Lisa Kruggel, Melanie Frank, Martina Jänicke, Norbert Marschner, TMK-Group (Tumour Registry Breast Cancer)

Abstract

Background: Several regimens for which efficacy was established in randomized controlled trials are recommended in current treatment guidelines for early breast cancer. However, knowledge on use and effectiveness of commonly administered chemotherapeutic agents in real-life care and across all breast cancer subtypes is limited.

Methods: The prospective, multicentre German TMK cohort study (Tumour Registry Breast Cancer) recruited patients in 148 oncology outpatient-centres. Data from 1650 patients who completed adjuvant chemotherapy were analysed regarding treatment regimens and taxane use from 2007 to 2014. The association of patient characteristics with application of taxane-free regimens was examined with a multivariate regression model.

Results: The preferred adjuvant treatment shifted from fluorouracil, anthracycline and cyclophosphamide containing regimens to anthracycline/taxane combinations. Taxane use increased for all subtypes, and the greatest rise was among node-negative patients. Older age, node-negativity, lower grading, HR-positive/HER2-negative subtype and earlier start year of therapy were significantly associated with taxane-free therapy.

Conclusions: Treatment with anthracycline/taxane-based chemotherapy in Germany has been rising for every subtype. The increased taxane use reflects updated guideline recommendations over the past decade. Cohort studies like the TMK provide insight into real-life treatment of patients outside of clinical trials.

Keywords: Adjuvant; Breast neoplasms; Chemotherapy; Cohort studies; Registries; Taxoids.

Conflict of interest statement

SD, CCS, DM, HT, LK, MF and MJ declare no conflict of interest concerning the topic of this publication. NM has received travel expenses from Roche, Novartis, Celgene and Amgen for attendance of advisory boards.

Figures

Fig. 1
Fig. 1
Cohort definition. Number of patients enrolled in the TMK until October 2014
Fig. 2
Fig. 2
Frequency of most commonly used regimens over time. Shown are the regimens used in more than 5% of the patients for a all patients, b patients with HR-positive/HER2-negative tumours, c patients with HER2-positive tumours and d patients with triple negative tumours. Each regimen could be administered with or without additional HER2-inhibitor and followed by additional endocrine therapy. A epirubicin or doxorubicin, C cyclophosphamide, D docetaxel, Car carboplatin, F fluorouracil, P paclitaxel
Fig. 3
Fig. 3
Frequency of taxane-use over time. a All patients as well as split up according to the subgroups, b HR-positive/HER2-negative, c HER2-positive and d triple negative. The line depicts the average for each group over time. pos. positive, neg. negative

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