The prevalence and predictors of adjuvant chemotherapy use among patients treated with neoadjuvant endocrine therapy.

Autor: Sella T; Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA., Kantor O; Harvard Medical School, Boston, MA, USA.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA., Weiss A; Harvard Medical School, Boston, MA, USA.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA., Partridge AH; Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA., Metzger O; Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA., King TA; Harvard Medical School, Boston, MA, USA. tking7@bwh.harvard.edu.; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. tking7@bwh.harvard.edu.; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. tking7@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2022 Aug; Vol. 194 (3), pp. 663-672. Date of Electronic Publication: 2022 Jun 25.
DOI: 10.1007/s10549-022-06647-8
Abstrakt: Purpose: Neoadjuvant endocrine therapy (NET) facilitates clinical response and breast conservation in hormone receptor-positive (HR-positive) breast cancer. Patient selection for adjuvant chemotherapy (CT) post-NET is unclear and potentially evolving with use of genomic assays. We evaluated post-NET CT use in a national dataset.
Methods: Using the National Cancer DataBase, we identified patients with cT2-3N0-3M0 HR-positive/human epidermal growth factor receptor 2-negative breast cancer treated between 2010 and 2017 with 3-12 months of NET prior to breast surgery. CT use was evaluated in the overall population, in patients with a pathologic complete response (pCR) and in patients with ypT1-2N0 disease (approximating PEPI 0). Exploratory analysis included patients > 50 years with ypN0-1, and 21-gene recurrence score (RS) ≤ 25 (approximating TAILORx/RxPONDER populations not benefiting from CT). Multivariable logistic regression was used to identify factors associated with CT.
Results: Among 3624 eligible patients, 20.4% (740/3624) received CT. On multivariable analysis, age ≤ 50, lobular histology, grade 2, progesterone receptor negativity, ypT3, ypN + and RS ≥ 18 were associated with CT receipt. Co-morbidity, longer NET duration, ypT4, ypNx, and RS < 18 were associated with CT omission. CT was administered to 3.3% (1/30) of patients experiencing pCR and 5.5% (82/1483) with ypT1-2N0 disease. Among patients > 50 years with ypT0-3N0-1 residual disease, 13.8% (355/2569) received CT; RS was available for 24.8% (88/355) and 60% (53/88) had a score 0-25.
Conclusion: A minority of patients receive CT post-NET. This decision appears to be driven by younger age, RS and pathological nodal status. Increased consideration of these factors prior to neoadjuvant treatment choice may be warranted.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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