Neoadjuvant treatment choice impacts invasive ductal carcinoma survival
medwireNews: Neoadjuvant chemotherapy may lead to better survival than neoadjuvant endocrine therapy in women with hormone receptor (HR)-positive, HER2-negative invasive ductal carcinoma (IDC) of the breast, show registry data from Taiwan.
Szu-Yuan Wu (Lotung Poh-Ai Hospital, Luodong Township, Taiwan) and co-investigators explain that although most women who receive neoadjuvant treatment are given chemotherapy, “endocrine therapy may be offered as an alternative for some women with strongly HR-positive and [HER2]-negative cancer.”
However, they write in JAMA Network Open that, “based on our results, we do not suggest [neoadjuvant endocrine therapy], especially for healthy patients with relatively few comorbidities.”
The study included 640 women (51% premenopausal) with strong HR-positive (≥50% nuclear staining on immunohistochemistry), HER2-negative IDC who received neoadjuvant endocrine therapy (22.7%) or chemotherapy (77.3%) before undergoing mastectomy between 2009 and 2016. The two groups were propensity score matched on variables including age, menopausal status, tumor characteristics, and surgery type.
The researchers report that pathologic responses were significantly worse among the women who received neoadjuvant endocrine therapy relative to those who received chemotherapy, with pathologic complete response rates of 6.2% versus 12.5% and downstaging rates of 20.0% versus 34.7%.
During a median 55.4 months of follow-up, 26.2% of women who received neoadjuvant endocrine therapy died. This rate was significantly higher than the mortality rate of 14.3% observed during 60.6 months of follow-up among the women who received neoadjuvant chemotherapy.
After adjustment for potential confounders, Wu and team found that women who received endocrine therapy had a significant 2.67-fold increased risk for death relative to those who received chemotherapy.
Other factors significantly associated with increased mortality risk included older age, being premenopausal, having more comorbidities, and having higher tumor stage and differentiation, but none of these factors increased mortality risk as much as endocrine therapy.
Wu et al say: “If a premenopausal woman refuses (or is an unfavorable candidate for) [neoadjuvant chemotherapy], physicians are suggested to proceed to surgical treatment, if possible, rather than attempt [neoadjuvant endocrine therapy].”
They add: “For patients who are concerned about the extent of definitive surgical treatment, [neoadjuvant endocrine therapy] may be offered, but patients should be advised that the data in this setting suggest superior pathologic responses, less residual tumor burden, and more favorable survival outcomes with chemotherapy than endocrine therapy.”
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