Shorter time to initiation of adjuvant chemotherapy after definitive surgery may reduce risk of relapse and improve clinical outcomes in patients with highly-proliferating early breast cancer, according to a study published in the European Journal of Cancer.

In a phase 3 trial, Italian researchers led by Alberto Farolfi, MD, randomly assigned 921 patients with early breast cancer who had rapidly-proliferating tumors to receive chemotherapy with or without anthracyclines. They wanted to evaluate the optimal time interval to commence chemotherapy after surgery in these patients.

With a median follow-up of 105 months, they used the Kaplan-Meier method to determine disease-free survival, overall survival, and 95 percent confidence intervals.

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The researchers found that prolonged time to initiation resulted in significant increase in risk of relapse. Upon time-dependent receiver-operating characteristic (ROC) curve analysis, they found that the best cut-off threshold for time to initiation of adjuvant chemotherapy and longer overall survival was 7 weeks, with 8-year overall survival found in 88% of patients with a time to initiation of less than 7 weeks and 78% in other patients.

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In addition, they found that time to initiation, tumor size and nodal involvement remained significantly associated with disease-free survival using a backward elimination procedure.

“Our results confirm that a shorter time to initiation of adjuvant chemotherapy may reduce relapses and possibly also improve clinical outcomes in patients with highly proliferating early breast cancer,” the authors concluded.


  1. Farolfi A, Scarpi E, Rocca A, et al. Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer. European Journal of Cancer. doi: July 20, 2015.