Use of neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States

Abstract

BACKGROUND Neoadjuvant chemotherapy (NAC) is the standard of care for patients with locally advanced breast cancer and can yield clinical advantages in individuals with lower stage cancers as well. To the authors' knowledge, the extent and patterns of use of NAC remain unknown. The objective of the current study was to assess temporal trends in NAC use and to examine what clinical, demographic, and treatment site characteristics influence its use. METHODS Data from the National Cancer Data Base regarding 395,486 patients with stage I to stage III breast cancer who received adjuvant or neoadjuvant chemotherapy in the United States from 2003 through 2011 were analyzed. Chi‐square tests and logistic regression analyses were used to assess the association between NAC use and patient, tumor, and facility characteristics. RESULTS Overall, 17.4% of patients received NAC, including 4% of patients with stage I disease, 17.8% of patients with stage II disease, and 41.6% of patients with stage III disease. NAC use increased over time from 12.2% to 24.0%, particularly among patients with more advanced cancers. Rates increased from 12.9% to 39.3% in patients with stage IIIA, from 72.3% to 86.4% in patients with stage IIIB, and from 30.1% to 59.3% in patients with stage IIIC cancers. On multivariate analysis, patients aged <60 years, African American individuals, and those treated in academic centers were more likely to receive NAC. NAC use also varied by geographic region and was the highest in the West South Central region (21%) and lowest in the Midwest (15.2%). CONCLUSIONS Although NAC use increased between 2003 and 2011, <50% of all patients with stage III breast cancer were treated with NAC. Substantial regional and practice‐related variations exist. Cancer 2015;121:2544–2552. © 2015 American Cancer Society.

Neoadjuvant Systemic Therapy in Breast Cancer: Use and Trends in Radiotherapy Practice

“…Use of nast was quite a bit lower than in another American study, which reported a nast rate of 17.4% 22 . All of those studies demonstrated variability by stage, centre 20 , surgeon 21 , and geographic region 22 , as in our cohort, for whom use of nast varied by cancer centre-a finding showing that, despite widely published guidelines 23,24 , potential biases based on region and training can affect patient care.…”

“…We had hypothesized that use of nast would increase during the study period, as reported by others 21,22 ; however, in our cohort, use of nast was relatively stable. The difference might be explained by our shorter time period (5 years compared with the 8 years used by Mougalian et al 22 ) or by significant increases in nast use after 2012 (the period used by Graham et al 21 ).…”

“…The difference might be explained by our shorter time period (5 years compared with the 8 years used by Mougalian et al 22 ) or by significant increases in nast use after 2012 (the period used by Graham et al 21 ). Notably, use of nast increased for earlystage disease (i-ii), but stayed stable for stage iii disease.…”

Dynamic evaluation of the immune infiltrate and immune function genes as predictive markers for neoadjuvant chemotherapy in hormone receptor positive, HER2 negative breast cancer

“…The increasing adoption and use of neoadjuvant chemotherapy (NACT) in early and locally advanced breast cancer (BC) in recent years 1 can be attributed to three factors: the demonstration that it confers similar long-term outcomes to postoperative therapy due to the early eradication of micrometastatic disease; 2, 3 the increase in breast conserving surgical procedures; and the fact that it offers an appropriate platform for in vivo testing of chemotherapy activity and discovery of prognostic and predictive biomarkers, due to the ease of response assessment and tissue extraction. Among the putative biomarkers that are under development is the quantitative and qualitative assessment of the immune infiltrate.…”

Robust identification of the cancer biomarker phosphocholine through partitioned envelopes in noisy magnetic resonance spectroscopic data by the non-parametric fast Padé transform

“…With NCT, more direct evaluation of breast cancer treatment effectiveness becomes possible [50]. Response to NCT for breast cancer is most often evaluated according to change in tumor size as manifested on MRI together with the pathological characteristics at subsequent surgery, both of which are relatively late indicators.…”