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Jamie DePolo: Hello, everyone. I’m Jamie DePolo, senior editor at Breastcancer.org. We’re podcasting from the 2018 San Antonio Breast Cancer Symposium. My guest is Dr. Zaida Morante, medical oncologist at INEN in Lima, Peru. We’re going to discuss her research that found delaying chemotherapy for more than 30 days after breast cancer surgery was linked to worse outcomes in people diagnosed with triple-negative disease.
Dr. Morante, welcome to the podcast.
Zaida Morante: Hi.
Jamie DePolo: First of all, all the people in the study had been diagnosed with early-stage, triple-negative disease, correct?
Zaida Morante: All the patients that we included in the study were stage I to III.
Jamie DePolo: One to III, okay. No one was treated with chemotherapy before surgery?
Zaida Morante: No. They underwent surgery first.
Jamie DePolo: Okay. They were all expected to have chemotherapy, correct?
Zaida Morante: Yeah. They're complete adjuvant chemotherapy.
Jamie DePolo: Okay. In your study, if I’m remembering correctly, you classified people into a couple different groups. One was 30 days or less that they got chemotherapy — that was 30 days or less after surgery, I should say, they got chemotherapy. Thirty-one to 60 days, 61 to 90 days, and 91 days or more after surgery. So of those groups, which was the most common time for the women — and I’m assuming it was all women?
Zaida Morante: The median was 41 days. Forty percent of our patients received between 31 and 60 days.
Jamie DePolo: Thirty-one and 60 days, okay. So that was the largest group as well, too?
Zaida Morante: Yeah, the largest group, but we have people receiving chemotherapy after 91 days, too.
Jamie DePolo: Okay. You did consider... Anything longer than 30 days was considered to be a delay, is that right?
Zaida Morante: Yes, because we did our methodology thinking with the study of two doctors that made that analysis before, and we used the cutoff at the 91 days because we have some population in that time.
Jamie DePolo: Okay. From your study, what did your results show? What were these worse outcomes if chemotherapy was delayed?
Zaida Morante: When people receive after 31 days, their risk of death increased 1.9-fold. It was significant for over-survival — this is for survival and this is recurrent for survival — with more than 10% of a difference.
Jamie DePolo: Okay. So, any type of survival... overall progression-free and disease-free?
Zaida Morante: ...disease-free.
Jamie DePolo: Okay. So that’s a pretty important thing to know if someone is scheduling chemotherapy. For your study, do we know at all why chemotherapy was delayed in any of the women? Do we have any... like a hint?
Zaida Morante: A percentage of our people, of our population, came from another institutions, of another hospitals, to us and to receive chemotherapy. So they underwent surgery in other hospitals and came with us with the treatment initiated. The other ones were diagnosed in our hospital, and we are a big institution, the main one, so we have a lot of population to attend and maybe that’s perhaps the delay.
Jamie DePolo: Okay. Your study was done in Peru, and if I’m remembering right, you said about 48% of the people had chemotherapy 31 days to 60 days after surgery, that was the largest chunk. Do you know how that would sort of relate to what is done in the United States? Is that common here as well?
Zaida Morante: We analyze the data before published and we saw the guidelines, and there is no exactly to time to initiate the chemotherapy. It’s not clear, but all recommend between 4 weeks and 6 weeks after surgery.
Jamie DePolo: Okay. I’m wondering, too, for your study, there have been some other research studies presented here that sort of suggested that maybe chemotherapy before surgery — neoadjuvant — might be a better option for people with triple-negative disease.
Zaida Morante: Yeah. The standard of treatment for this kind of patients is neoadjuvant chemotherapy now.
Jamie DePolo: It is? Okay.
Zaida Morante: Not for all, but for stage II and III. I think this study helps to understand that maybe chemotherapy... The patients have to receive chemotherapy as soon as possible. Neoadjuvant chemotherapy is the better way to do the systemic treatment.
Jamie DePolo: Okay. When you’re treating patients diagnosed with triple-negative disease, is that something you would suggest to them, or how do you see these results being used in the clinic?
Zaida Morante: For our institution, it’s very important. We have to do plan to start before the treatment, for us and for all the institutions, they have to view their results and analyze the population. Maybe they can use us, our study, to analyze their population and to establish that if it’s useful for them to start before the treatment, and we have to start neoadjuvant chemotherapy for our patients, to start to use more.
Jamie DePolo: Okay. Thank you very much for your time, Dr. Morante. I appreciate it.
Zaida Morante: Thank you.
