From 1999 to 2008, major changes have taken place in chemotherapy for early and metastatic disease in China, reflecting the inclusion of key evidence and guidelines into Chinese medical practice, according to the first nationwide multicenter study of chemotherapy in Chinese breast cancer patients presented at the European Society of Medical Oncology (ESMO) Asia 2016 Congress held in Singapore.

A retrospective analysis of demographic and pathological data, along with chemotherapeutic information, was conducted to assess the trends and factors associated with chemotherapeutic decisions in Chinese females with breast cancer. A total of 4,211 breast cancer patients were randomly selected from representative hospitals of seven geographic regions in China between 1999 and 2008.

Adjuvant chemotherapy (ACT) was administered to 3,271 cases (77.7 percent), neoadjuvant chemotherapy (NACT) to 558 (13.3 percent), and chemotherapy for metastatic disease to 392 (9.3 percent). [Li Q, et al, ESMO Asia 2016]

ACT use was affected by independent factors such as age, stage, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status in adjuvant settings (p<0.001). The respective frequencies of ACT in stage I, II and III cases were 69.1, 83.2 and 93.9 percent. The respective ACT frequencies in age groups of ≤39, 40 to 49, 50 to 59, 60 to 69 and ≥70 years were 84.2, 81.9, 79.5, 65.6 and 28.3 percent.

There was a significant reduction in the percentage of CMF (cyclophosphamide, methotrexate and 5-fluorouracil) in ACT from 51.2 to 1.3 percent between 1999 and 2008, and a significant increase in the use of regimens containing both anthracyclines and taxanes from 14.4 to 45.4 percent. On the other hand, anthracycline-based (without taxanes) regimens had a dramatic increase in the first 5 years from 15.3 to 54.5 percent and a gradual decrease to 26.8 percent in 2008.

There were more locally advanced patients who received NACT than earlier stage patients (24.1 vs 9.2 percent; p<0.001). During this period, the percentage of regimens containing anthracycline and taxanes rose from 2.4 to 43.8 percent. Meanwhile, anthracyline-based (without taxanes) regimens increased in the first 6 years from 24.4 to 70.4 percent and decreased to 30.0 percent in 2008.

In first-line chemotherapy, combined regimen was administered to 87.5 percent of cases. Of these, 34.9 percent received anthracyclines and taxanes, followed by taxanes plus platinum (21.7 percent) and vinorelbine plus platinum (16.5 percent).

The mean age at diagnosis was 48.7 years, with breast cancer peaking in the age group 40 to 49 years (38.6 percent). Infiltrating ductal carcinoma was the most common subtype (86.5 percent). Clinical stage I and II accounted for 60.6 percent of the total number of participants. [BMC Cancer 2011;11:364]

Surgery was the predominant treatment option (96.9 percent), followed by chemotherapy (81.4 percent). Fewer patients underwent radiotherapy and endocrine therapy (22.6 and 38.0 percent, respectively).

“The Government oriented campaign to raise awareness will need to be expanded and continued,” researchers said. “The most updated clinical guideline will also need to be disseminated to doctors at all levels to benefit the patients, ultimately improving the prognosis in Chinese breast cancer patients.”