Rethinking neoadjuvant chemotherapy for breast cancer

Vaidya, Jayant S; Massarut, Samuele; Vaidya, Hrisheekesh J; Alexander, Emma; Richards, Thomas M.; Caris, Jochem; Sirohi, Bhawna; Tobias, Jeffrey

doi:10.1136/bmj.j5913

Cited by 90 publications

(72 citation statements)

References 34 publications

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“…7 In addition, a low androgen state is a known risk factor for MBC. 8 In the last 20 years, there has been significant progress in the local and systemic management of female breast cancer, [9][10][11][12][13] but it is unclear whether these advances have been applied to the management of MBC. Therefore, the objective of the current study was to describe treatment patterns of MBC in the United States and to identify associated prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century

Yadav

Karam

Riaz

et al. 2019

Cancer

103

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Background Male breast cancer (MBC) is a rare disease for which there is limited understanding of treatment patterns and prognostic factors. Methods Men with TNM stage I to stage III breast cancer diagnosed between 2004 and 2014 in the National Cancer Data Base were included. Trends in treatment modalities were described using the average annual percentage change (AAPC) and estimated using Joinpoint software for the analysis of trends. Kaplan‐Meier curves and the multivariate Cox proportional hazards regression model were used to compare survival between subgroups and to identify prognostic factors. Results A total of 10,873 MBC cases were included, with a median age at diagnosis of 64 years. Breast‐conserving surgery was performed in 24% of patients, and 70% of patients undergoing breast conservation received radiotherapy. Approximately 44% of patients received chemotherapy, and 62% of patients with estrogen receptor–positive disease received endocrine therapy. Oncotype DX was ordered in 35% of patients with lymph node–negative, estrogen receptor–positive/human epidermal growth factor receptor 2 (HER2)‐negative tumors. During the study period, there was a significant increase in the rates of total mastectomy, contralateral prophylactic mastectomy, radiotherapy after breast conservation, ordering of Oncotype DX, and the use of endocrine therapy (P < .05). On multivariate analysis, factors found to be associated with worse overall survival were older age, black race, higher Charlson Comorbidity Index, high tumor grade and stage of disease, and undergoing total mastectomy. Residing in a higher income area; having progesterone receptor–positive tumors; and receipt of chemotherapy, radiotherapy, and endocrine therapy were associated with better overall survival. Conclusions Despite the lack of prospective randomized trials in patients with MBC, the results of the current study demonstrated that the treatment of this disease has evolved over the years. These findings further the understanding of the modern treatment and prognosis of MBC, and identify several areas for further research.

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Section: Introductionmentioning

confidence: 99%

Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century

Yadav

Karam

Riaz

et al. 2019

Cancer

103

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“…Indications have evolved and now relate to a combination of patient and clinical factors, including early eradication of micrometastatic disease, and reducing tumor size to allow breast‐conserving surgery (BCS) in patients who would otherwise require mastectomy. The use of NACT is increasing (7%‐27% of new cancer diagnoses), but there is little specific data on its utilization.…”

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confidence: 99%

Neo‐adjuvant chemotherapy and surgical planning: Survey of practice, attitudes, and opinions in the UK

2019

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Neo-adjuvant chemotherapy (NACT) was first used in the treatment of breast cancer to increase the likelihood of surgical resection for locally advanced disease and to assess the sensitivity of tumors to different chemotherapy regimens. Indications have evolved and now relate to a combination of patient and clinical factors, including early eradication of micrometastatic disease, and reducing tumor size to allow breast-conserving surgery (BCS) in patients who would otherwise require mastectomy. The use of NACT is increasing (7%-27% of new cancer diagnoses 1 ), but there is little specific data on its utilization.

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“…Neo-adjuvant chemotherapy has been widely used for breast cancer treatment due to the effective pathologic responses seen with newer therapeutic agents. 2 Recently, it has also been introduced for the treatment of early breast cancer. 3…”

Section: Letter To the Editor/responsementioning

confidence: 99%

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confidence: 99%

Letter to the Editor/Response

et al. 2019

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Neo-adjuvant chemotherapy has been widely used for breast cancer treatment due to the effective pathologic responses seen with newer therapeutic agents. 2 Recently, it has also been introduced for the treatment of early breast cancer. 3 Despite this, there is ongoing debate and controversies related to the use of neo-adjuvant chemotherapy in breast cancer (critically appraised in a recent review by Vaidya et al 2 ).We find Dr Altundag's point regarding our neo-adjuvant cohort quite valid. In our study, ~43% of patients with invasive apocrine carcinoma (IAC) presented at the advanced stage (III or IV) with only 19% of the patients having the tumor size ≤2 cm at presentation. This is mainly due to the lack of organized screening program at the national level. In this regard, our small IAC cohort treated in neo-adjuvant setting is somehow biased but it essentially reflected the previous and current overall breast cancer presentation in Bosnia and Herzegovina. Consequently, the response rates to neo-adjuvant therapy in our study may be different from the previously published data. Noteworthy, IAC is a rare breast cancer subtype (~1%-2% of all breast cancers) 4,5 and future larger and multi-institutional studies are required to validate the effectiveness of (neo)adjuvant chemotherapy in patients with IAC. O RCI D Semir Vranichttps://orcid.org/0000-0001-9743-7265 R E FE R E N C E S1. Imamovic D, Bilalovic N, Skenderi F, et al. A clinicopathologic study of invasive apocrine carcinoma of the breast: a single-center experience. Breast J. 2018;24(6):1105-1108. 2. Vaidya JS, Massarut S, Vaidya HJ, et al. Rethinking neoadjuvant chemotherapy for breast cancer. BMJ. 2018;360:j5913. 3. Cain H, Macpherson IR, Beresford M, Pinder SE, Pong J, Dixon JM. Neoadjuvant therapy in early breast cancer: treatment considerations and common debates in practice. Clin Oncol (R Coll Radiol).

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Rethinking neoadjuvant chemotherapy for breast cancer

Abstract: As evidence questioning the rationale behind neoadjuvant chemotherapy in breast cancer grows, Jayant Vaidya and colleagues say we must reconsider the current treatment options

Cited by 90 publications

References 34 publications

Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century

Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century

Neo‐adjuvant chemotherapy and surgical planning: Survey of practice, attitudes, and opinions in the UK

Letter to the Editor/Response

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