Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer.

Journal Article (Journal Article)

BACKGROUND: Controversy exists regarding the optimal sequence of chemotherapy among women with operable node-negative breast cancers with high-risk tumor biology. We evaluated national patterns of neoadjuvant chemotherapy (NACT) use among women with early-stage HER2+, triple-negative (TNBC), and high-risk hormone receptor-positive (HR+) invasive breast cancers. METHODS: Women ≥18 years with cT1-2/cN0 HER2+, TNBC, or high recurrence risk score (≥31) HR+ invasive breast cancers who received chemotherapy were identified in the National Cancer Database (2010-2016). Cochran-Armitage and logistic regression examined temporal trends and likelihood of undergoing NACT versus adjuvant chemotherapy based on patient age and molecular subtype. RESULTS: Overall, 96,622 patients met study criteria; 25% received NACT and 75% underwent surgery first, with comparable 5-year estimates of overall survival (0.90, 95% CI 0.892-0.905 vs 0.91, 95% CI 0.907-0.913). During the study period, utilization of NACT increased from 14% to 36% and varied according to molecular subtype (year*molecular subtype p < 0.001, p-corrected < 0.001). Women with HER2+ (OR 4.17, 95% CI 3.70-4.60, p < 0.001, p-corrected < 0.001) and TNBC (OR 3.81, 95% CI 3.38-4.31, p < 0.001, p-corrected < 0.001) were more likely to receive NACT over time, without a change in use among those with HR+ disease (OR 1.58, 95% CI 0.88-2.87, p = 0.13, p-corrected = 0.17). CONCLUSION: Among women with early-stage triple-negative and HER2+ breast cancers, utilization of NACT increased over time, a trend that correlates with previously reported improved rates of pCR and options post-neoadjuvant treatment with residual disease. Future research is needed to better understand multidisciplinary decisions for NACT and implications for breast cancer patients.

Full Text

Duke Authors

Cited Authors

  • Prakash, I; Neely, NB; Thomas, SM; Sammons, S; Blitzblau, RC; DiLalla, GA; Hyslop, T; Menendez, CS; Plichta, JK; Rosenberger, LH; Fayanju, OM; Hwang, ES; Greenup, RA

Published Date

  • February 2022

Published In

Volume / Issue

  • 11 / 4

Start / End Page

  • 1099 - 1108

PubMed ID

  • 34989142

Pubmed Central ID

  • PMC8855910

Electronic International Standard Serial Number (EISSN)

  • 2045-7634

Digital Object Identifier (DOI)

  • 10.1002/cam4.4517


  • eng

Conference Location

  • United States