Antitumor activity and efficacy of shorterversuslonger duration of anthracycline-taxane neoadjuvant chemotherapy in stage II–III HER2-negative breast cancer: a 10-year, retrospective analysis

Abstract

Background: Neoadjuvant anthracycline-taxane-based chemotherapy (ChT) is a standard of care treatment option for stage II–III breast cancer (BC) patients. However, the optimal duration of neoadjuvant ChT has been poorly investigated so far. Material and methods: We retrospectively retrieved clinical data of patients with stage II–III human epidermal growth factor receptor 2-negative (HER2–) BC who were treated between October 2007 and January 2018 with neoadjuvant AT (doxorubicin-paclitaxel) for three cycles followed by CMF (cyclophosphamide-methotrexate-5-fluorouracil) for three cycles (cohort A) or with four AT cycles followed by four CMF cycles (cohort B). The aim of our study was to investigate the impact of neoadjuvant ChT duration (cohort A versus cohort B) on pathological complete response (pCR) rates, disease-free survival (DFS) and overall survival (OS). Results: Of 209 HER2– BC patients included, 62 had triple-negative breast cancer (TNBC) and 147 had hormone receptor-positive (HR+) BC. Median age was 48 years (range 30–74 years). A total of 111 patients belonged to cohort A and 98 patients belonged to cohort B. pCR was detected in 29 (13.9%) patients, 25 (40.3%) of whom had TNBC and four (2.7%) had HR+ HER2– BC. Patients achieving pCR had significantly longer DFS and OS, with statistical significance reached only in patients with TNBC. We found no differences between cohort A and cohort B in terms of pCR rates (15.3% versus 12.2%; p = 0.55), DFS ( p = 0.49) or OS ( p = 0.94). The incidence of grade 3/4 adverse events was similar in cohort A versus cohort B as well (22.5% versus 19.4%; p = 0.54). Conclusion: Shorter duration of neoadjuvant anthracycline-taxane ChT was not associated with worse clinical outcomes in patients with stage II–III BC. Prospective studies are needed to evaluate whether the duration of neoadjuvant anthracycline-taxane-based ChT can be reduced in specific patient subgroups without negatively affecting clinical outcomes.

Localised breast cancer: neoadjuvant chemotherapy impact evaluation on the pathological complete response (PCR) in a lower middle-income country

“…The results from large randomised clinical trials have shown that neo-adjuvant and adjuvant chemotherapy is associated with similar long-term outcomes [ 5 , 16 , 17 ]. Preoperative chemotherapy has the advantage of being able to induce a reduction in tumour size [ 5 , 16 ].…”

“…The results from large randomised clinical trials have shown that neo-adjuvant and adjuvant chemotherapy is associated with similar long-term outcomes [ 5 , 16 , 17 ]. Preoperative chemotherapy has the advantage of being able to induce a reduction in tumour size [ 5 , 16 ]. Furthermore, the antitumor activity of neoadjuvant chemotherapy can provide valuable prognostic information, as patients achieving a PCR have significantly longer DFS and OS, especially for TN or HER2+ BC [ 18 , 19 ].…”

“…This sequence followed by surgery remains the current recommended therapeutic strategy for the management of locally advanced BC. The standard chemotherapy protocol is a sequential treatment with an anthracycline/epirubicin + cyclophosphamide (AC or EC) followed by taxanes (T), with or without anti-human epidermal growth factor receptor 2 (anti-HER2) treatment depending on the expression of the HER2 protein on immunohistochemistry (IHC) [ 5 , 8 ].…”

“…Over the past decades, neoadjuvant therapy has become a preferred option in locally advanced, [1] inflammatory, node-positive, triplenegative (TN), or human epidermal growth factor receptor 2 (HER2) -overexpressing, non-metastatic breast cancers (BCs) [2][3][4]. It has the advantage of being able to induce a reduction in tumour size [5], and provides valuable prognostic information, as patients achieving a pathological complete response (PCR) have significantly longer disease-free survival (DFS) and overall survival (OS) [6,7]. In addition, postoperative therapy decisions are affected by pathologic response to neoadjuvant therapy.…”

Profile, treatment patterns, and influencing factors of anthracycline use in breast cancer patients in China: A nation‐wide multicenter study

“…Currently, regimens that include doxorubicin are listed in The National Comprehensive Cancer Network guidelines as an alternative option in all risk levels and stages of breast cancer except for the lowest risk and early‐stage breast cancer 3 . However, the use of other anticancer agents has led to the study of a greater number of combinations of chemotherapeutic drugs in specific patients, and consequently anthracycline‐based chemotherapy (ABC) has been in decline for decades 8,9 . Additionally, anthracyclines exert remarkable adverse effects and among them, cardiotoxicity is the main one.…”