Current clinical practice and outcome of neoadjuvant chemotherapy for early breast cancer: analysis of individual data from 94,638 patients treated in 55 breast cancer centers

Abstract

Neoadjuvant chemotherapy (NACT) is frequently used in patients with early breast cancer. Randomized controlled trials have demonstrated similar survival after NACT or adjuvant chemotherapy (ACT). However, certain subtypes may benefit more when NACT contains regimes leading to high rates of pathologic complete response (pCR) rates. In this study we analyzed data using the OncoBox research from 94,638 patients treated in 55 breast cancer centers to describe the current clinical practice of and outcomes after NACT under routine conditions. These data were compared to patients treated with ACT. 40% of all patients received chemotherapy. The use of NACT increased over time from 5% in 2007 up to 17.3% in 2016. The proportion of patients receiving NACT varied by subtype. It was low in patients with HR-positive/HER2-negative breast cancer (5.8%). However, 31.8% of patients with triple-negative, 31.9% with HR-negative/HER2-positive, and 26.5% with HR-positive/HER2-positive breast cancer received NACT. The rates of pCR were higher in patients with HR-positive/HER2-positive, HR-negative/HER2-positive and triple-negative tumors (36, 53 and 38%) compared to HR-positive/HER2-negative tumors (12%). PCR was achieved more often in HER2-positive and triple-negative tumors over time.This is the largest study on use and effects of NACT in German breast cancer centers. It demonstrates the increased use of NACT based on recommendations in current clinical guidelines. An improvement of pCR was shown in particular in HER2-positive and triple-negative breast cancer, which is consistent with data from randomized controlled trails.

Prediction of clinical response to neoadjuvant therapy in advanced breast cancer by baseline B-mode ultrasound, shear-wave elastography, and pathological information

“…Because of the overexpression of the oncogene ERBB2, HER2+ promotes the growth of cancer cells, which results in positive progress and a worse prognosis ( 26 ). However, as a therapeutic target, HER2+ BC has been proven to be more sensitive to targeted therapy than other IHC subtypes ( 27 , 28 ). In each prediction model, HER2+ showed a great contribution that reemphasized its importance.…”

Stellungnahme von DGGG und DGS – Positionspapier zur Ambulantisierung der operativen Medizin

“…Die Behandlungsergebnisse von Patientinnen mit Brustkrebs, die zu > 90% in zertifizierten Brustzentren in Deutschland behandelt werden, sind besser als in nicht zertifizierten Kliniken, wie Publikationen in wissenschaftlichen Zeitschriften zeigen 3 4 5 . Es konnte außerdem gezeigt werden, dass die Behandlung von Frauen mit Brustkrebs in zertifizierten Brustzentren über die Zeit immer spezieller, d. h. an die Tumorbiologie angepasster und effektiver (messbare Parameter wie pathologische Komplettremission), geworden ist 4 , 5 .…”

The Role of Level III Dissection in Locally Advanced Breast Cancer following Neoadjuvant Chemotherapy—A Prospective Study

“…15 The current pathological complete response (pCR) rate is 12% in hormone receptor (HR)-positive, HER2-negative, 36% in HR-positive, HER2-positive, 38% in triple-negative, and 55% in HR-negative, HER2-positive cancer. 16 Thus, there is possibility of residual disease in level III in a significant proportion of patients. In our institute, we routinely perform complete axillary dissection of all III levels in the post-NACT setting.…”