Time trends of neoadjuvant chemotherapy for early breast cancer

Riedel, Fabian; Hoffmann, Ann Sophie; Moderow, Mareike; Heublein, Sabine; Deutsch, Thomas M.; Golatta, Michael; Wallwiener, Markus; Schneeweiß, Andreas; Heil, Joerg; Hennigs, André

doi:10.1002/ijc.33122

Cited by 37 publications

(21 citation statements)

References 44 publications

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“…The highest portions of NACT have been in university hospitals. Nonetheless, over the past decade, rising pCR rates were observed in all hospital settings, concordant with previous analyses for this database [16].…”

Section: Discussionsupporting

confidence: 91%

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Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

et al. 2021

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Background: Over the past decade, chemotherapy has been used more selectively in early breast cancer (EBC) due to better risk stratification. Neoadjuvant chemotherapy (NACT) has evolved to the primary treatment option. The type and size of hospitals is known to have a substantial influence on the kinds of treatment they provide, and therefore on patient outcomes (e.g. rates for pathological complete response, pCR), but it is not yet known how this has affected delivery of chemotherapy for EBC in Germany. Methods: This study analyzed chemotherapy use and pCR rates after NACT for EBC patients treated at 104 German institutions 2008e2017. Institutions were separated into associated hospital type (university hospital; teaching hospital; community hospital) and annual caseload ( 100; 101e250; >250 cases/ year). Results: Overall, 124,084 patients were included, of whom 11.6% were treated at university hospitals, 63.1% at teaching hospitals, and 25.3% at community hospitals. In total, 46,274 (37.3%) received chemotherapy, of whom 44,765 had information available about systemic treatment and surgery. From 2008 to 2017, chemotherapy use declined from 48.3% to 36.4% for university hospitals, from 40.7% to 30.3% for teaching hospitals, and from 42.4% to 33.7% for community hospitals. Furthermore, the proportion of NACT increased the most in university hospitals (from 32.0% to 68.1%); whereas, the rate of pCR (defined as ypT0 ypN0) increased irrespective of institutional type. Analyses regarding annual caseload did not show any differences. Conclusions: The results from this large, nationwide cohort reflect a more selective use of chemotherapy in Germany, irrespective of institutional type or case load.

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Section: Discussionsupporting

confidence: 91%

“…The detailed criteria for positivity of the hormone receptors (HR), i.d. ER and PR, and the HER2 status have been described before [16]. HR was defined as negative if both ER/PR were negative, and as positive if ER or PR were positive.…”

Section: Definitions Of Tumor Histology Stages and Subtypesmentioning

confidence: 99%

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

et al. 2021

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“…In the molecular era, clinical indications for NACT have expanded, such that neoadjuvant strategies are considered in early-stage and operable disease [ 78 , 79 ]. There has been a reported increase in NACT prescription in early breast cancer between 2008 and 2017 (20% vs. 57.7%) [ 80 ] and the increased use occurs across all molecular subtypes [ 81 ]. While these expansion of indications for NACT may imply progressive practice in the setting of breast carcinoma, clinicians should proceed with caution within the context of ILC disease – the current analysis suggests these patients are not as well served with NACT as global perceptions may believe.…”

Section: Discussionmentioning

confidence: 99%

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

et al. 2022

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Meta-analysis of >87,000 patients demonstrates that patients with invasive lobular carcinoma of the breast are far less likely to achieve pCR of the breast or axilla compared to their ductal counterparts, receive less BCS and more frequently return positive margins. Background Neoadjuvant chemotherapy (NACT) facilitates tumour downstaging, increases breast conserving surgery (BCS) and assesses tumour chemosensitivity. Despite clinicopathological differences in Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC), decision making surrounding the use NACT does not take account of histological differences. Aim To determine the impact NACT on pathological complete response (pCR), breast conserving surgery (BCS), margin status and axillary pCR in ILC and IDC. Methods A systematic review was performed in accordance with the PRISMA guidelines. Studies reporting outcomes among ILC and IDCs following NACT were identified. Dichotomous variables were pooled as odds ratios (ORs) with 95% confidence intervals_(CI) using the Mantel-Haenszel method. P- values <0.05 were statistically significant. Results 40 studies including 87,303 (7596 ILC [8.7%]and 79,708 IDC [91.3%]) patients were available for analysis. Mean age at diagnosis was 54.9 vs. 50.9 years for ILC and IDC, respectively. IDCs were significantly more likely to achieve pCR (22.1% v 7.4%, OR: 3.03 [95% CI 2.5–3.68] p < 0.00001), axillary pCR (23.6% vs. 13.4%, OR: 2.01 [95% CI 1.77–2.28] p < 0.00001) and receive BCS (45.7% vs. 33.3%, OR 2.14 [95% CI 1.87–2.45] p < 0.00001) versus ILCs. ILCs were significantly more likely to have positive margins at the time of surgery (36% vs 13.5%, OR 4.84 [95% CI 2.88–8.15] p < 0.00001). Conclusion This is the largest study comparing the impact of NACT among ILC and IDC with respect to pCR and BCS. ILC has different outcomes to IDC following NACT and incorporate it into treatment decisions and future clinical guidelines.

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“…The clinical stage, but not the pathologic stage, of breast cancer was compared in this study. Since 2010, the proportion of neoadjuvant chemotherapy has increased regardless of the tumor subtype [ 18 ]. Many patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative primary breast cancer attempted to postpone surgery in favor of neoadjuvant endocrine therapy during the COVID-19 pandemic [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on the Diagnosis and Surgery of Breast Cancer: A Multi-Institutional Study

et al. 2021

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Purpose The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the rates of screening, case identification, and referral for cancer diagnosis. We investigated the diagnosis and surgery status of breast cancer before and after the COVID-19 pandemic at a multi-institutional level. Methods We collected breast cancer data from the clinical data warehouse which contained the medical records of patients from six academic institutions in South Korea. Patients were divided into two groups: February to April (period A) and May to July (period B). The data from the two groups were then compared against the same periods in 2019 and 2020. The primary objective was to investigate the differences in breast cancer stages before and after the COVID-19 pandemic. Results Among 3,038 patients, there was a 9.9% reduction in the number of diagnoses in 2020. This decrease was more significant during period A than period B. The breast cancer stage was not statistically different in period A ( p = 0.115), but it was in period B ( p = 0.001). In the subset analysis according to age, there was a statistical difference between 2019 and 2020 in period B for patients under the age of 65 years ( p = 0.002), but no difference was observed in the other groups. Conclusion The number of breast cancer cases declined during the pandemic, and the staging distribution has changed after the pandemic peak.

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Time trends of neoadjuvant chemotherapy for early breast cancer

Cited by 37 publications

References 44 publications

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

Impact of the COVID-19 Pandemic on the Diagnosis and Surgery of Breast Cancer: A Multi-Institutional Study

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