P199 Neoadjuvant systemic therapy for breast cancer: a survey of Australian and New Zealand specialists

A Decision Aid for Women Considering Neoadjuvant Systemic Therapy for Operable Invasive Breast Cancer: Development and Protocol of a Phase II Evaluation Study (ANZ1301 DOMINO)

“…Neoadjuvant systemic therapy (NAST) has become a routine treatment option for selected women with operable breast cancer, endorsed by international guidelines [ 1 , 2 ], patients [ 3 ], doctors [ 4 ], and breast cancer advocates [ 5 ]. We estimate that at least 20% of patients with breast cancer might benefit from NAST; however, this rate varies among clinicians [ 6 ]. It has the advantages of down-staging some larger tumors from mastectomy to lumpectomy [ 7 ], providing prognostic information depending on the degree of tumor response [ 8 ], and facilitating translational research for early biomarkers of response [ 9 ].…”

“…Despite these advantages, NAST is not frequently used for women with operable disease, with one Australian study reporting an estimated rate of 2.75% [ 4 ], and in the United States 3.8% [ 13 ]. Possible reasons for this low rate of NAST use include the need for changes in workflow practices, patient expectation for upfront surgery, patient lack of awareness of NAST, and lack of available clinical trials [ 6 ]. Potential disadvantages to NAST include the loss of detailed pathology to guide multidisciplinary management; the (low) potential to delay surgery in patients who do not respond to NAST; and reduced time between surgery and radiotherapy, which may impact on breast reconstruction outcomes [ 4 ].…”