Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study

Abstract

Background: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. Methods: Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. Results: In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. Conclusion: There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.

Neoadjuvant Treatment of Breast Cancer - Advances and Limitations

“…In this issue of Breast Care, Gaß et al [5] explore which HR-positive patients should receive adjuvant and neoadjuvant chemotherapy. The treatment of these patients is a challenge because they have a good prognosis but often do not respond to chemotherapy.…”

Using Probability for Pathological Complete Response (pCR) as a Decision Support Marker for Neoadjuvant Chemotherapy in HER2 Negative Breast Cancer Patients – a Survey Among Physicians

“…Other studies have also examined decision-making parameters for neoadjuvant chemotherapy in hormone receptor-positive patients. A large prospective noninterventional study in postmenopausal women showed that age, body mass index, tumor grade, HER2 status, and the fact that patients were taking concomitant medication were influencing factors in relation to decision-making for or against neoadjuvant chemotherapy 24 . Information about the patientʼs pCR status could further add to this list of influencing factors.…”

Comment on “The Relationship Between Lymph Node Ratio and Survival Benefit With Adjuvant Chemotherapy in Node-positive Esophageal Adenocarcinoma”

“…Based on our experience and previous studies, the number of lymph nodes is just one aspect of consideration for AC, some other factors (eg, general condition, economic status, comorbidities, toxicity of drug, etc) also play essential role in decision making. [11][12][13] Only when we take all these factors into consideration comprehensively rather than comparing the number or ratio of positive lymph nodes alone, can we make the best recommendation for patients with esophageal adenocarcinoma.…”