December 13, 2016

Neoadjuvant Chemo No Better Than Adjuvant Chemo in Non-Metastatic Triple Negative Breast Cancer

By Brian Hoyle

SAN ANTONIO, Tex -- December 13, 2016 -- Neoadjuvant chemotherapy fairs no better than adjuvant chemotherapy in terms of overall survival (OS) for patients with non-metastatic triple negative breast cancer (TNBC), researchers reported here at the 39th Annual San Antonio Breast Cancer Symposium (SABCS).

The adjusted 4-year OS of patients receiving neoadjuvant chemotherapy was 81.9%. The rate for those patients who received adjuvant chemotherapy was 85.3%.

“In the National Cancer Database study, the survival of patients with triple negative breast cancer receiving neoadjuvant chemotherapy was not meaningfully different from survival of patients receiving adjuvant chemotherapy, even after adjusting for demographic, tumour, and treatment factors,” said Yee Chung Cheng, MD, Medical College of Wisconsin, Milwaukee, Wisconsin, on December 9.

A strength of neoadjuvant chemotherapy in breast cancer is the ability to achieve early disease control at a microscopic level, prior to tumour formation. This should result in better survival. Yet, clinical trial data has not indicated a survival benefit for the approach in high-risk patients, such as TNBC.

Clinical trial populations can be relatively small. To better assess the influence of neoadjuvant chemotherapy on survival, a bigger dataset is needed.

For the current study, the researchers exploited the National Cancer Database, a nationwide, hospital-based outcomes database that contains information from over 1500 accredited cancer programs in the United States.

Data was obtained from 15,483 women aged 18 years and older at the time of diagnosis who had been diagnosed with stage I to III TNBC in 2010 or 2011. All had received either neoadjuvant chemotherapy (n = 4,335) or adjuvant chemotherapy (n = 11,248).

The actual survival numbers in those receiving adjuvant chemotherapy was 11,174 at 0 months, 10,245 at 20 months, 4,548 at 40 months, and 0 at 60 months. The corresponding numbers for those receiving neoadjuvant chemotherapy were 4,244 at 0 months, 3,819 at 20 months, 1,488 at 40 months, and 1 at 60 months.

Notable caveats of the study are the lack of information on the chemotherapy regimen used and whether the chemotherapy regimen was completed. These factors can affect disease response and disease outcome.
“Patient and tumour factors at the time of disease presentation that are important in determining which triple negative patients will benefit from a neoadjuvant approach still need to be studied,” said Dr. Cheng.

[Presentation title: Overall Survival of Patients With Non-Metastatic Triple Negative Breast Cancer Who Received Neoadjuvant vs Adjuvant Chemotherapy: Cohort Analysis of National Cancer Data Base (NCDB) 20100-2011. Abstract P5-16-09]

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