Real-world outcomes in young women with breast cancer treated with neoadjuvant chemotherapy

Abstract

Breast cancer in young women has been shown to have an aggressive behavior and worse prognosis. Studies evaluating young women enrolled in clinical trials of neoadjuvant chemotherapy have shown that age is a determinant factor in the achievement of a pathological complete response (pCR). In this study, we sought to analyze the outcomes of young patients treated with neoadjuvant chemotherapy at a single institution. 1639 patients treated with neoadjuvant chemotherapy were included. 316 patients ≤40 years were compared with 1323 patients aged >40 years regarding the achievement of a pCR (defined as no invasive residual tumor in the breast or lymph nodes). Disease-free survival (DFS) and overall survival were compared between groups according to pCR status and subtype, defined by hormone receptor (HR) and HER2 status. Young women were more likely to have a pCR than their older counterparts (37.4 vs. 26.3 %, P < 0.001). This difference was significant both for HR+/HER2- and triple-negative (TN) tumors. Young age and achieving less than pCR were associated with a greater chance of recurrence for the entire population. Age was not an independent factor for recurrence in TN and HER2+ disease. However, being younger than 40 increased recurrence risk in HR+/HER2- tumors. The achievement of a pCR was not associated with improved DFS in young women with HR+/HER2- tumors. Although young women have a high rate of pCR, they also have a worse prognosis. In a real-world clinical setting, the achievement of a pCR was an independently significant protective factor for recurrence across all subtypes and ages, except for HR+, HER2- disease in young women.

Project profile: a multicenter study on breast cancer in young women in Latin America (PRECAMA study)

“…In Latin America, the proportion of incident BC cases among women younger than 45 years is about 20%, whereas in North America and the European Union the proportions are about 12%. 3 Similarly, mortality data show an important difference in the proportion between Latin America (14%) and Western countries (7%). 3 Although the age distribution differs substantially between Western and Latin American countries, the large number of incident BC cases currently observed among young women in Latin America can only be partly explained by the population age structure.…”

“…3 Similarly, mortality data show an important difference in the proportion between Latin America (14%) and Western countries (7%). 3 Although the age distribution differs substantially between Western and Latin American countries, the large number of incident BC cases currently observed among young women in Latin America can only be partly explained by the population age structure. 4 The Latin American population is culturally and genetically heterogeneous, with varying ancestral backgrounds, and the proportion of BC that is due to hereditary factors appears to vary with ethnicity.…”

“…1,2 It is estimated that one-third of these cancers occur in women younger than 50 years. 3 However, this proportion varies according to geographical region and socioeconomic status. In Latin America, the proportion of incident BC cases among women younger than 45 years is about 20%, whereas in North America and the European Union the proportions are about 12%.…”

“…BC is a heterogeneous disease, and the presence or absence of estrogen receptor (ER) and/or progesterone receptor (PR) expression, as well as the molecular pathological characteristics, are key determinants of the tumor clinical behavior and response to treatment. 3,7 BC in young women has aggressive characteristics, in particular a high proportion of triple-negative and human epidermal growth factor receptor 2 (HER2)-positive (HER2+) cancers, 8 high risks of local recurrence and of contralateral BC, 9 and high mortality associated with advanced stage at diagnosis. 8,9 Genetic background and/or different environmental exposures (including lifestyle, dietary habits, and sedentary behaviors) are likely to shape BC tumor characteristics and cancer progression.…”

Caracterização do impacto dos regimes quimioterápicos na reserva ovariana de pacientes com câncer de mama

“…Entretanto, por razões ainda desconhecidas, o câncer de mama em mulheres jovens é associado com características prognósticas desfavoráveis e maiores taxas de recorrência quando comparado com mulheres diagnosticadas em idade avançada . Por essas razões a maioria das mulheres diagnosticadas com câncer de mama em idade reprodutiva será tratada com tratamento quimioterápico (Villarreal-Garza et al, 2016). antraciclina-ciclofosfamida sem taxano (AC); ciclofosfamida, metotrexato e 5-fluorouracil (CMF); taxano e ciclofosfamida (TC); epirubicina e ciclofosfamida (EC); e taxano (T).…”