Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy

O’Neil, Daniel S.; Nietz, Sarah; Buccimazza, Ines; Singh, Upasana; Čačala, Sharon; Stopforth, Laura; Joffe, Maureen; Jacobson, Judith S.; Neugut, Alfred I.; Crew, Katherine D.; Ruff, Paul; Cubasch, Herbert

doi:10.1634/theoncologist.2018-0535

Cited by 13 publications

(16 citation statements)

References 41 publications

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“…114 The electronic literature search conducted to inform this section of the neoadjuvant therapy guideline identified 14 articles (from a total of 101 abstracts) on the topic of health disparities. 88,[115][116][117][118][119][120][121][122][123][124][125][126][127] The available studies evaluated associations between a range of clinical and sociodemographic factors and the use and outcomes of neoadjuvant therapy for breast cancer. Killelea et al, 122 for example, examined racial differences in the frequency and outcomes of neoadjuvant chemotherapy use and reported that neoadjuvant chemotherapy was given more frequently to African American, Hispanic, and Asian women than to White women (P 5 .001).…”

Section: Health Disparitiesmentioning

confidence: 99%

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Korde

Somerfield

Carey

et al. 2021

JCO

513

336

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PURPOSE To develop guideline recommendations concerning optimal neoadjuvant therapy for breast cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the literature on neoadjuvant therapy for breast cancer and provide recommended care options. RESULTS A total of 41 articles met eligibility criteria and form the evidentiary basis for the guideline recommendations. RECOMMENDATIONS Patients undergoing neoadjuvant therapy should be managed by a multidisciplinary care team. Appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those in whom residual disease may prompt a change in therapy. Neoadjuvant therapy can also be used to reduce the extent of local therapy or reduce delays in initiating therapy. Although tumor histology, grade, stage, and estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) expression should routinely be used to guide clinical decisions, there is insufficient evidence to support the use of other markers or genomic profiles. Patients with triple-negative breast cancer (TNBC) who have clinically node-positive and/or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; those with cT1a or cT1bN0 TNBC should not routinely be offered neoadjuvant therapy. Carboplatin may be offered to patients with TNBC to increase pathologic complete response. There is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy. In patients with hormone receptor (HR)-positive (HR-positive), HER2-negative tumors, neoadjuvant chemotherapy can be used when a treatment decision can be made without surgical information. Among postmenopausal patients with HR-positive, HER2-negative disease, hormone therapy can be used to downstage disease. Patients with node-positive or high-risk node-negative, HER2-positive disease should be offered neoadjuvant therapy in combination with anti-HER2-positive therapy. Patients with T1aN0 and T1bN0, HER2-positive disease should not be routinely offered neoadjuvant therapy. Additional information is available at www.asco.org/breast-cancer-guidelines .

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Section: Health Disparitiesmentioning

confidence: 99%

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Korde

Somerfield

Carey

et al. 2021

JCO

513

336

View full text Add to dashboard Cite

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“…Furthermore, we enriched our cohort with patients with stage III/IV tumours by using cell blocks, making our sample more representative of the 'real' breast cancer population. Moreover, unlike retrospective series with high losses to follow-up (up to 48%), [15][16][17][18][19] only 9% of our patients were considered lost.…”

Section: Discussionmentioning

confidence: 80%

“…Our cohort study has many advantages compared with other African reports. [15][16][17][18][19] We used ISH to assess HER2equivocal cases and evaluated Ki67, and as such were able to categorise surrogate intrinsic subtypes according to the St. Gallen classification, which is often used to Values in bold are considered to be statistically significant. *p value for the univariate survival analysis.…”

Section: Discussionmentioning

confidence: 99%

“…13 Additionally, there is a paucity of data regarding breast cancer treatment and survival according to the different subtypes in African countries. [15][16][17][18][19] This knowledge may allow for a better management and organisation of healthcare services in this low-resource setting, translating into improved outcomes for patients with breast cancer.…”

Section: Introductionmentioning

confidence: 99%

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Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique

et al. 2020

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BackgroundData regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients’ treatment and survival. The concordance of biomarker assessment between cytological and histological samples was also evaluated.MethodsProspective cohort study including 210 patients diagnosed between January 2015 and August 2017, followed to November 2019. Clinicopathological characteristics, treatment, 3-year overall survival (OS) and disease-free survival (DFS) were compared across classic tumour subtypes (oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (St. Gallen classification). Concordance was measured using Cohen’s κ statistics.ResultsA total of 51% of patients had ER-positive/HER2-negative tumours, 24% HER2-positive and 25% TNBC. Concordance between cytological and histological samples regarding ER and HER2 status was substantial (κ=0.762 and κ=0.603, respectively). There were no significant differences across subtypes regarding clinical characteristics and treatment, except for HIV positivity and high histological grade (more prevalent among TNBC) or endocrine therapy (higher use among ER-positive/HER2-negative and HER2-positive patients). Three-year OS was 52.5% (95% CI, 44.3% to 60.0%), being higher in ER-positive/HER2-negative (61.1%) compared with HER2-positive (53.2%) and TNBC (31.9%) patients. Adjusted HRs were 1.96 (95% CI, 1.13 to 3.39) among HER2-positive and 3.10 (95% CI, 1.81 to 5.31) among TNBC versus ER-positive/HER2-negative patients. Three-year DFS was 46.6% (95% CI, 38.0% to 54.8%), being lower among TNBC versus ER-positive/HER2-negative patients (HR 2.91; 95% CI, 1.64 to 5.16). Results were similar between surrogate intrinsic subtypes.ConclusionThere was a high proportion of HER2-positive and TNBC among Mozambican patients and their survival was poor compared with ER-positive/HER2-negative patients, partly due to the limited treatment options. A systematic assessment of ER, PR and HER2 status is feasible and may help tailoring and optimise the treatment of patients with breast cancer in low-resource settings, potentially leading to survival gains in this underserved population.

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“…Delays in receiving neoadjuvant or adjuvant chemotherapy involve an interplay of sociocultural elements and resource constraints even within a single SSA country. 36 Improving access through regulatory mechanisms, improved quality of imports, compulsory licensing, and implementation of universal health care would likely improve outcomes. 37 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Breast Cancer Management in Sub-Saharan Africa

Vanderpuye

Dadzie

Huo

et al. 2021

JCO Global Oncology

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PURPOSE To document progress and bottlenecks in breast cancer management in sub-Saharan Africa, subsequent to a 2013 pilot survey conducted through the African Organization for Research and Treatment in Cancer (AORTIC) network. METHODS An anonymous survey of breast cancer management was conducted in 2018 among AORTIC members. Results concerning respondent specialty, access to tumor boards, treatment accessibility, diagnostic services, and factors influencing treatment outcomes were compared with the 2013 findings. RESULTS Thirty-seven respondents from 30 facilities in 21 sub-Saharan Africa countries responded. The majority (92%) were clinical oncologists. Radiotherapy facilities were available in 70% of facilities. Seventy-eight percent of these had linear accelerators, and 42% had cobalt60 machines. Eighty percent of facilities had multidisciplinary tumor boards. Immunohistochemistry was routinely performed in 74% of facilities, computed tomography scan in 90%, bone scan in 16%, and positron emission tomography scans in 5%. Anthracyclines, taxanes, tamoxifen, letrozole, anastrozole, and zoledronic acid were available in the majority; trastuzumab, fertility, and genetic counseling were available in 66%, 58%, and 16%, respectively. There were a 50% increase in oncologist respondents over 2013 and a > 50% increase in radiotherapy facilities, particularly linear accelerators. Availability of trastuzumab, aromatase inhibitors, and taxanes increased. Immunohistochemistry capacity remained the same, whereas facilities harvesting at least 10 axillary lymph nodes increased. Bone scan facilities decreased. Responses suggested improved diagnostic services, systemic therapies, and radiotherapy. Sociocultural and economic barriers, system delays, and advanced stage at presentation remain. CONCLUSION Clinicians in sub-Saharan Africa have basic tools to improve breast cancer outcomes, recording positive strides in domains such as radiotherapy and systemic therapy. Socioeconomic and cultural barriers and system delays persist. Workforce expansion must be prioritized to improve quality of care to improve outcomes.

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Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy

Cited by 13 publications

References 41 publications

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique

Assessment of Breast Cancer Management in Sub-Saharan Africa

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