The continued evidence from overviews: what is the clinical utility?
The Oxford Overview process has provided us with extremely high-powered meta-analyses assessing the role of adjuvant chemotherapy in early breast cancer. From the most recent publication, the proportional benefits from chemotherapy are relatively equivalent across all patient subgroups, a finding contradictory to our growing understanding of the role of tumour biology in dictating chemosensitivity. Several factors, including heterogeneity of patient groups and chemotherapy regimens, lack of data on underlying tumour biological subtypes, and confounding effect of chemotherapy-induced ovarian suppression in premenopausal women with hormone receptor positive breast cancer, impact on the applicability and clinical utility of the Overview in current and future oncological practice. With these considerations, the Overview has become less clinically relevant as a tool for guiding adjuvant chemotherapy treatment decisions, and a new direction is required.
'Sandro Pitigliani' Medical Oncology Unit, Department of Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy.
Natalie
N
Turner
Laura
L
Biganzoli
Luca
L
Malorni
Ilenia
I
Migliaccio
Erica
E
Moretti
Marta
M
Pestrin
Giuseppina
G
Sanna
Olimpia
O
Siclari
Angelo
A
Di Leo
D000328:Adult; D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D019317:Evidence-Based Medicine; D005260:Female; D018734:Genes, erbB-2 / Q000235:genetics; D006801:Humans; D007558:Italy; D008408:Mastectomy / Q000379:methods; D008495:Medical Oncology / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
Adjuvant chemotherapy; Breast cancer; Heterogeneity; Molecular subtypes; Oxford Overview; Proportional benefit