• Neoadjuvant chemotherapy:
    • Is often given in early stage triple negative breast cancers
    • It has the benefit of:
      • Increased rates of breast conservation
      • As well as the prognostic value of assessing tumor response to systemic therapy
  • Overall survival is equivalent with chemotherapy:
    • Administration either adjuvantly or neoadjuvantly
  • The dosing of the chemotherapy in breast cancer:
    • Should be given in a dose-dense fashion:
      • For example every 2 weeks instead of every 3 weeks
    • In a meta-analysis by the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG):
      • Dose-dense delivery of chemotherapy was found to improve:
        • 10-year recurrence risk
        • Breast cancer mortality
        • All-cause mortality
    • If there are no medical contraindications:
      • The preferred delivery of chemotherapy should be dose-dense
  • The chemoregimen docetaxel plus cyclophosphamide (TC) is not the preferred regimen for a patient with lymph node positive and triple negative disease:
    • In the Anthracyclines in Early Breast Cancer (ABC) trials:
      • Three cooperative group trials underwent a combined analysis to determine the activity of TC compared to regimens containing anthracycline, cyclophosphamide and taxane in HER2-negative early breast cancers
      • The primary endpoint was:
        • Invasive disease-free survival (IDFS)
      • This trial enrolled over 4,000 patients and was stopped early due to inferior IDFS in the TC group
      • Exploratory subgroup analysis:
        • Suggested benefit of an anthracycline regimen was particularly meaningful with triple negative tumors

References

1. Mougalian SS, Soulos PR, Killelea BK, Lannin DR, Abu-Khalaf MM, DiGiovanna MP, et al. Use of neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States. Cancer. 2015;121(15):2544-2552.

2. Gray R, Bradley R, Braybrooke J, Liu Z, Peto R, Davies L, et al. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet. 2019;393(10179):1440-1452.

3. Blum JL, Flynn PJ, Yothers G, Asmar L, Geyer CE Jr, Jacobs SA, et al. Anthracyclines in early breast cancer: the ABC Trials—USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 (NRG Oncology). J Clin Oncol. 2017;35(23):2647-2655.

4. Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013;24(9):2278-2284.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s