Open Access Open Badges Research article

Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study

Matteo Clavarezza116*, Giorgio Mustacchi2, Andrea Casadei Gardini3, Lucia Del Mastro4, Andrea De Matteis5, Ferdinando Riccardi6, Vincenzo Adamo7, Enrico Aitini8, Domenico Amoroso9, Paolo Marchetti10, Stefania Gori11, Francesco Carrozza12, Evaristo Maiello13, Francesco Giotta14, Davide Dondi15 and Marco Venturini1

Author Affiliations

1 Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy

2 Ospedale Civile, Centro Oncologico, Trieste, Italy

3 IRST, Meldola, Forlì, Italy

4 IRRCS A.O.U. San Martino IST, Genoa, Italy

5 Istituto Nazionale Tumori, Naples, Italy

6 AORN Cardarelli, Naples, Italy

7 A.O. Policlinico G. Martino, Messina, Italy

8 A.O. Carlo Poma, Mantova, Italy

9 Ospedale Unico Versilia, Lido di Camaiore, Lucca, Italy

10 A.O. S. Andrea, Rome, Italy

11 Ospedale Santa Maria della Misericordia, Perugia, Italy

12 Ospedale A. Cardarelli, Campobasso, Italy

13 IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

14 IRCCS Oncologico, Bari, Italy

15 Sanofi-Aventis, Milan, Italy

16 Oncology Department, Ospedale Sacro Cuore Don Calabria Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy

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BMC Cancer 2012, 12:216  doi:10.1186/1471-2407-12-216

Published: 6 June 2012



International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters.


An observational study (NEMESI) was conducted in 63 Italian oncology centres in patients with early breast cancer. Age, performance status, concomitant disease, menopausal status, histology, tumor dimension (pT), axillary lymph node status (pN), grading (G), estrogen and progesterone receptor (ER and PgR), proliferative index (ki67 or MIB-1), human epidermal growth factor receptor 2 (HER2) and type of adjuvant treatment were recorded. The primary objective of the study was to define parameters influencing the decision to prescribe adjuvant chemotherapy and the type of chemotherapy.


Data for 1894 patients were available. 69.0% postmenopausal, 67.0% pT1, 22.3% pTmic/pT1a/pT1b, 61.0% pN0, 48.7% luminal A, 18.1% luminal B, 16.1% HER2 positive, 8.7% triple negative, 8.4% unknown. 57.8% received adjuvant chemotherapy: 38.1% of luminal A, 67.3% luminal B, 88.2% HER2-positive, 97.6% triple negative. Regimens administered: 9.1% CMF-like, 48.8% anthracyclines, 38.4% anthracyclines plus taxanes, 3.7% taxanes alone. Increasing pT/pN and, marginally, HER2-positive were associated with the prescription of anthracyclines plus taxanes. Suboptimal schedules (CMF-like or AC/EC or FEC-75) were prescribed in 37.3% receiving chemotherapy, even in HER2-positive and triple negative disease (36.5% and 34.0%, respectively).


This study showed an overprescription of adjuvant chemotherapy for early breast cancer, particularly referred to luminal A. pT, pN and, marginally, HER2 were the principal determinants for the choice of chemotherapy type. Suboptimal chemotherapy regimens were adopted in at least one third of HER2-positve and triple negative.