Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer

Morante, Zaida; Ruiz, Rossana; Araujo, Jhajaira M.; Pinto, Joseph A.; Cruz-Ku, Gabriel De la; Urrunaga-Pastor, Diego; Namuche, Fernando; Flores, Claudio; Mantilla, Raúl; Luján, Maria; Fuentes, Hugo; Schwarz, Luis J.; Aguilar, Alfredo; Neciosup, Silvia P.; Gómez, Henry L.

doi:10.1016/j.clbc.2020.09.008

Cited by 25 publications

(16 citation statements)

References 21 publications

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“…The adjuvant treatment rate in our study aligns with similar contemporary cohorts 14,35 and was initiated at a median of 44 days after surgery. However, recent studies 36‐38 have shown improved outcomes in TNBC patients starting AT within 30 days, highlighting a critical opportunity for improvement. Future studies to examine factors that contribute to treatment delays in AT and barriers to NAT are warranted.…”

Section: Discussionmentioning

confidence: 99%

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

et al. 2020

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Section: Discussionmentioning

confidence: 99%

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

et al. 2020

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“…Especially patients with stage III of breast cancer, trastuzumab-treated Her2-positive tumors and triple negative carcinomas had inferior outcomes when time to chemotherapy was longer than 60 days compared to a therapy onset below 30 days after surgery [4]. Consistently, recurrence-free survival and overall survival decreases in patients with triple-negative breast cancer when chemotherapy started more than 30 days after surgery [5]. However, these studies investigated adjuvant chemotherapy settings, where chemotherapy is performed after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…There is compelling evidence that a delayed therapy onset of adjuvant chemotherapy worsen outcome [4,5], which was also shown for neoadjuvant settings [6]. Sanford et al reported worse outcome when time to surgery exceeds 8 weeks after NACT [6].…”

Section: Introductionmentioning

confidence: 98%

Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients

Müller

Juhasz-Böss

Schmidt

et al. 2020

Arch Gynecol Obstet

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Purpose It is suspected that delayed surgery after neoadjuvant chemotherapy (NACT) leads to a worse outcome in breast cancer patients. We therefore evaluated possible influencing factors of the time interval between the end of NACT and surgery. Methods All patients receiving NACT due to newly diagnosed breast cancer from 2015 to 2017 at the Department of Gynecology, Saarland University Medical Center, were included. The time interval between end of NACT and surgery was defined as primary endpoint. Possible delaying factors were investigated: age, study participation, outpatient and inpatient presentations, implants/expander, MRI preoperatively, discontinuation of chemotherapy, and genetic mutations. Results Data of 139 patients was analyzed. Median age was 53 years (22–78). The time interval between end of NACT and surgery was 28 days (9–57). Additional clinical presentations on outpatient basis added 2 days (p = 0.002) and on inpatient basis added 7 days to time to surgery (p < 0.001). Discontinuation of NACT due to chemotherapy side effects prolonged time to surgery by 8 days (p < 0.001), whereas discontinuation due to disease progress did not delay surgery (p = 0.6). In contrast, a proven genetic mutation shortened time to surgery by 7 days (p < 0.001). Patient’s age, participation in clinical studies, oncoplastic surgery, and preoperative MRI scans did not delay surgery. Conclusion Breast care centers should emphasize a reduction of clinical presentations and a good control of chemotherapy side effects for breast cancer patients to avoid delays of surgery after NACT.

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“…To our knowledge no studies are published investigating the impact of NACT delay on survival. In the adjuvant setting, CT delays above 30 days have been associated with worse overall and disease free survival, especially in TNBC [25,27]. In an umbrella trial, Khorana et al found a significant impact of time to treatment initiation with any treatment modality [19].…”

Section: Discussionmentioning

confidence: 99%

“…Using NART in 5 fractions with SIB should result in even a shorter OTT, since the waiting time between surgery and RT is omitted. Treatment delays, not only between symptoms and diagnosis, but also between diagnosis and surgery or start of NACT, have been associated with worse survival for aggressive tumors like TNBC, although the causality remains questionable [ [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. Consequently, changing treatment sequences should not result in a delay between diagnosis and the surgery or the first treatment.…”

Section: Introductionmentioning

confidence: 99%

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

Vakaet¹,

Hulle²,

Koen³

et al. 2022

The Breast

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Objective Neo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT. Material and methods Twenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy. Results 20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196–253) compared to the control group (mean 237, range 211–268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications. Conclusion This pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.

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Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer

Cited by 25 publications

References 21 publications

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

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