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Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit

  • Alexandre de NonnevilleEmail author
  • Camille Jauffret
  • Anthony Gonçalves
  • Jean-Marc Classe
  • Monique Cohen
  • Fabien Reyal
  • Chafika Mazouni
  • Marie-Pierre Chauvet
  • Nicolas Chopin
  • Pierre-Emmanuel Colombo
  • Eva Jouve
  • Emile Darai
  • Roman Rouzier
  • Charles Coutant
  • Pierre Gimbergues
  • Anne-Sophie Azuar
  • Christine Tunon de Lara
  • Eric Lambaudie
  • Gilles Houvenaeghel
Clinical Trial

Abstract

Background

Invasive lobular carcinomas (ILCs) represent approximately 10% of all breast cancers. Despite this high frequency, benefit of adjuvant chemotherapy (CT) is still unclear.

Methods

Our objective was to investigate the impact of CT on survival in ILC. Patients were retrospectively identified from a cohort of 23,319 patients who underwent primary surgery in 15 French centers between 1990 and 2014. Only ILC, hormone-positive, human epidermal growth factor 2 (HER2)-negative patients who received adjuvant endocrine therapy (ET) were included. End-points were disease-free survival (DFS) and overall survival (OS). A propensity score for receiving CT, aiming to compensate for baseline characteristics, was used.

Results

Of a total of 2318 patients with ILC, 1485 patients (64%) received ET alone and 823 (36%) received ET + CT. We observed a beneficial effect of addition of CT to ET on DFS and OS in multivariate Cox model (HR = 0.61, 95% confidence interval, CI [0.41–0.90]; p = 0.01 and 0.52, 95% CI [0.31–0.87]; p = 0.01, respectively). This effect was even more pronounced when propensity score matching was used. Regarding subgroup analysis, low-risk patients without CT did not have significant differences in DFS or OS compared to low-risk patients with CT.

Conclusion

ILC patients could derive significant DFS and OS benefits from CT, especially for high-risk patients.

Keywords

Adjuvant chemotherapy Breast cancer Lobular Hormone receptor-positive 

Abbreviations

CI

Confidence interval

CT

Adjuvant chemotherapy

DFS

Disease-free survival

EC

Endocrine therapy

HER2

Human epidermal growth factor 2

HR

Hazard ratio

IDC

Invasive duct carcinoma of no special type

IHC

Immunohistochemistry

ILC

Invasive lobular carcinoma

LVI

Lymphovascular invasion

OR

Odds ratio

OS

Overall survival

SBR

Scarff, Bloom, and Richardson

Notes

Funding

This academic work did not receive financial support from any funding source.

Author contributions

AN, CJ, AG, and GH contributed to literature search, figures, study design, data analysis, data interpretation, and writing. All authors have participated in the data collection. All authors have critically reviewed the final version of the manuscript and approved its content. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Conceptualization AN, CJ, AG, GH. Data curation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Formal analysis AN, CJ, AG, GH. Investigation AN, CJ, AG, GH. Methodology AN, CJ, AG, GH. Project administration AN. Supervision AG, GH. Validation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Visualization AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Writing AN, CJ, AG, GH. Review and editing AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH.

Compliance with ethical standards

Conflict of interest

Authors have nothing to disclose.

Ethical Approval

All procedures performed in this study involving human participants were done in accordance with the French Ethical Standards and with the 2008 Helsinki Declaration. As this was a retrospective non-interventional study, no formal personal consent was required.

Supplementary material

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Supplementary material 3 (DOCX 30 KB)
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Supplementary material 4 (DOCX 32 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alexandre de Nonneville
    • 1
    Email author
  • Camille Jauffret
    • 2
  • Anthony Gonçalves
    • 1
  • Jean-Marc Classe
    • 3
  • Monique Cohen
    • 2
  • Fabien Reyal
    • 4
  • Chafika Mazouni
    • 5
  • Marie-Pierre Chauvet
    • 6
  • Nicolas Chopin
    • 7
  • Pierre-Emmanuel Colombo
    • 8
  • Eva Jouve
    • 9
  • Emile Darai
    • 10
  • Roman Rouzier
    • 11
  • Charles Coutant
    • 12
  • Pierre Gimbergues
    • 13
  • Anne-Sophie Azuar
    • 14
  • Christine Tunon de Lara
    • 15
  • Eric Lambaudie
    • 2
  • Gilles Houvenaeghel
    • 2
  1. 1.Department of Medical OncologyAix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCMMarseilleFrance
  2. 2.Department of Surgical OncologyAix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCMMarseilleFrance
  3. 3.Institut René Gauducheau, Site hospitalier NordSt HerblainFrance
  4. 4.Institut CurieParisFrance
  5. 5.Institut Gustave RoussyVillejuifFrance
  6. 6.Centre Oscar LambretLilleFrance
  7. 7.Centre Léon BérardLyonFrance
  8. 8.Centre Val d’AurelleMontpellierFrance
  9. 9.Centre Claudius RegaudToulouseFrance
  10. 10.Hôpital TenonParisFrance
  11. 11.Centre René HugueninSaint CloudFrance
  12. 12.Centre Georges François LeclercDijonFrance
  13. 13.Centre Jean PerrinClermont-FerrandFrance
  14. 14.Chemin de ClavaryHôpital de GrasseGrasseFrance
  15. 15.Institut BergoniéBordeauxFrance

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