Utilization of Neoadjuvant Chemotherapy Varies in the Treatment of Women with Invasive Breast Cancer

Abstract

BackgroundTreatment with neoadjuvant chemotherapy (NAC) has made it possible for some women to be successfully treated with breast conservation therapy (BCT ) who were initially considered ineligible. Factors related to current practice patterns of NAC use are important to understand particularly as the surgical treatment of invasive breast cancer has changed. The goal of this study was to determine variations in neoadjuvant chemotherapy use in a large multi-center national database of patients with breast cancer. MethodsWe evaluated NAC use in patients with initially operable invasive breast cancer and potential impact on breast conservation rates. Records of 2871 women ages 18-years and older diagnosed with 2907 invasive breast cancers from January 2003 to December 2008 at four institutions across the United States were examined using the Breast Cancer Surgical Outcomes (BRCASO) database. Main outcome measures included NAC use and association with pre-operatively identified clinical factors, surgical approach (partial mastectomy [PM] or total mastectomy [TM]), and BCT failure (initial PM followed by subsequent TM). ResultsOverall, NAC utilization was 3.8%l. Factors associated with NAC use included younger age, pre-operatively known positive nodal status, and increasing clinical tumor size. NAC use and BCT failure rates increased with clinical tumor size, and there was significant variation in NAC use across institutions. Initial TM frequency approached initial PM frequency for tumors >30-40mm; BCT failure rate was 22.7% for tumors >40mm. Only 2.7% of patients undergoing initial PM and 7.2% undergoing initial TM received NAC. ConclusionsNAC use in this study was infrequent and varied among institutions. Infrequent NAC use in patients suggests that NAC may be underutilized in eligible patients desiring breast conservation.

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

“…The incidence of nast in British Columbia is similar to that in other reports, including the reported 3.8% use of nast in 4 large U.S. treatment centres 20 and the 8.5% use in another Canadian province 21 . Use of nast was quite a bit lower than in another American study, which reported a nast rate of 17.4% 22 .…”

“…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.…”

“…With emerging data suggesting that a pathology assessment of response in lymph nodes might inform the need for nodal irradiation 16,33 , the importance of adequate initial nodal staging is increasing. At a minimum, fine-needle aspiration should be attempted before nast [adequate for eligibility to enrol in nsabp B-51/Radiation Therapy Oncology Group 1304 (nrg 9353) 20 and recommended by the U.S. National Comprehensive Cancer Network 23 ].…”

“…However, a meta-analysis and subgroup analysis of the nsabp B-18 and B-27 trials indicate that patients with a pathologic complete response in the axilla have a low risk of lr relapse 16,33 . That observation has led to the current nsabp B-51/Radiation Therapy Oncology Group 1304 (nrg 9353) 20 trial addressing the question of whether nodal rt can be omitted after nodal pathologic complete response with nast. Until those results are available (in 2025 or beyond), uncertainty will remain about whether post-nast nodal status can be used to exclude the benefit of regional rt for pathologically positive nodes.…”

Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study

“…With regard to neoadjuvant chemotherapy, age and BMI were the only factors that were predictive for the administration of neoadjuvant chemotherapy in the group of patients who received chemotherapy. Rates of neoadjuvant chemotherapy vary widely within institutions and between countries [37]. In a study in the United States, the rate of utilization of neoadjuvant chemotherapy was reported to be around 3% [37].…”