Neoadjuvant chemotherapy may not expedite treatment for breast cancer
Neoadjuvant chemotherapy did not appear to expedite treatment compared with adjuvant chemotherapy for women with breast cancer, according to study findings published in Cancer Medicine.
“We repeatedly hear from colleagues that chemotherapy administered in the neoadjuvant setting compared with the adjuvant setting gets patients to treatment faster than performing surgery first,” Richard J. Bleicher, MD, FACS, professor in the department of surgical oncology at Fox Chase Cancer Center, told Healio. “In some circles, especially among medical oncologists and even some surgeons, this seems to be assumed as fact.
“To illustrate, after we started this study, we submitted a different manuscript about the effect of delays on outcomes for various subtypes of breast cancer in the non-neoadjuvant setting. One of the reviewers of that manuscript asserted that neoadjuvant chemotherapy must be done first for some breast cancer subtypes because it is a definitively faster and more efficient treatment paradigm. However, there is no data to support this conventional wisdom.”
For this reason, Bleicher and colleagues evaluated times to initiation and completion of breast cancer treatment with neoadjuvant vs. adjuvant chemotherapy among 155,606 women (mean age, 54.4 ± 11.3 years; 74.8%, white) included in the National Cancer Database.
All women underwent both surgery and chemotherapy for nonrecurrent, noninflammatory, clinical stage I to stage III breast cancer diagnosed between 2004 and 2015.
Researchers compared treatment times of women who underwent neoadjuvant chemotherapy (n = 28,241) with those of women who underwent adjuvant chemotherapy (n = 127,365).
Women in the neoadjuvant group were younger (mean age, 51.9 ± 11.6 years vs. 54.9 ± 11.1 years; P < .0001), had larger tumors at presentation (clinical T stage III-IV, 35.8% vs. 4.9%; P < .0001) and had greater nodal involvement (clinical N stage II-III, 14.4% vs. 3.7%; P < .0001).
Results showed no significant difference in mean time from diagnosis to treatment initiation, adjusted for stage and other factors, between the adjuvant and neoadjuvant groups (35.4 days vs. 36.1 days). Adjusted comparisons also showed the neoadjuvant group had a significantly longer time to initiation of radiotherapy (mean, 240.8 days vs. 218.2 days; P < .0001) and start of endocrine therapy (mean, 301.6 days vs. 275.7 days; P < .0001).
Unplanned hospital readmission rates appeared slightly lower among women in the neoadjuvant group (1.18%) compared with the adjuvant group (1.72%). Both the neoadjuvant and adjuvant groups had low rates of 30-day mortality (0.04% vs. 0.01%) and 90-day mortality (0.3% vs. 0.08%).
“If a particularly long surgical delay is anticipated, then starting chemotherapy to avoid that delay may be reasonable,” Bleicher told Healio. “However, people should be aware that U.S. data show it takes at least as long to get patients to neoadjuvant chemotherapy as it does to get them to surgery when it is the first modality, even when adjusting for stage and other factors.”
Moreover, the general concern that women with triple-negative breast cancer require neoadjuvant chemotherapy due to the aggressiveness of the tumor may not be true, Bleicher said.
“It is true that these tumors tend to metastasize earlier than other phenotypes, but we have previously published that the effect of preoperative delays on outcomes in the non-neoadjuvant setting is not different for patients who have triple-negative tumors vs. other phenotypes — and here, we note that neoadjuvant chemotherapy is not faster or more efficient in getting patients through their treatment,” Bleicher told Healio. “This means that giving patients with triple-negative breast cancer their chemotherapy upfront solely because it is felt to be more urgent is not supported by data. We are continuing to monitor and assess the effects of delays on patients in a variety of settings.” – by Jennifer Southall
For more information:
Richard J. Bleicher, MD, FACS, can be reached at Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA 19111; email: richard.bleicher@fccc.edu
Disclosures: The authors report no relevant financial disclosures.
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