NSABP B-18 and NSABP B-27 Trial

  • The NSABP B-18 trial:
    • Evaluated whether four cycles of doxorubicin and cyclophosphamide (AC) given preoperatively improved DFS and OS when compared with the same regimen given postoperatively
    • Results showed:
      • No statistically significant differences in DFS or OS between the two groups
      • Secondary aims included the evaluation of preoperative chemotherapy in down staging the primary breast tumor and involved axillary lymph nodes:
        • With preoperative chemotherapy, 13% of patients achieved pCR
      • Patients who received preoperative chemotherapy were:
        • More likely to receive breast-conserving surgery (67% vs. 60%, P=0.002) than patients receiving postoperative chemotherapy
  • The NSABP B-27 trial:
    • Evaluated the addition of docetaxel (T) either preoperatively or postoperatively to preoperative AC chemotherapy
    • These results showed that the addition of T:
      • Did not significantly impact DFS or OS, but when given preoperatively:
        • Significantly increased the number of patients who achieved a pathologic complete response (pCR):
          • 26% v 13%, p<0.0001
      • In both studies, patients who achieved a pCR had significantly improved DFS and OS compared to those who did not (P=0.0001)
  • References
    • Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15(7):2483- 2493.
    • Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001(30):96-102.
    • Bear HD, Anderson S, Smith RE, Geyer CE, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019-2027.
    • Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27 J Clin Oncol. 2008;26(5):778-785.

#Arrangoiz #BreastSurgeon #BreastCancer #SurgicalOncology #NSABPB18 #NSABPB27 #Miami #Mexico

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