Does preoperative MRI accurately stratify early-stage HER2 + breast cancer patients to upfront surgery vs neoadjuvant chemotherapy?

2021 ◽  
Author(s):  
Astrid Botty van den Bruele ◽  
Emanuela Ferraro ◽  
Varadan Sevilimedu ◽  
Molly P. Hogan ◽  
Sidra Javed-Tayyab ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Her2 Breast Cancer

Rate of use of NCCN “preferred” chemotherapy regimens for the treatment of HER2 positive breast cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 163-163
Author(s):  
Eric J. Gratias ◽  
Margaret Rausa ◽  
Lee N. Newcomer ◽  
Kurt Andrews ◽  
Nick Andrews ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Treatment Options ◽  
Management Program ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Nccn Guidelines ◽  
Her2 Breast Cancer

163 Background: The National Comprehensive Cancer Network (NCCN) Guidelines represent a well-established standard of care for the treatment of HER2+ breast cancer patients. eviCore healthcare is a licensee of NCCN that uses the NCCN guidelines to support its proprietary chemotherapy management program. All regimens assigned NCCN Category of Evidence 1, 2A, or 2B are adherent treatments in the eviCore program. NCCN recommends many systemic treatment options for HER2+ breast cancer, and a limited group is designated by NCCN as “preferred” based on superior efficacy and/or safety. This study evaluated the frequency of NCCN-preferred regimen use by practicing oncologists in HER2+ breast cancer patients. Methods: Chemotherapy authorizations for all HER2+ breast cancer patients with ≥ 1 injectable drug from 4/1/2015-9/30/2016 for multiple payers were included; > 90% of authorizations occurred in United HealthCare members. Cases with incomplete data were excluded. 3685 fully evaluable cases were stratified by stage, ER/PR status, and NCCN-preferred vs. NCCN-recommended status. The frequency of NCCN-preferred regimen selection was calculated for each subgroup. Results: There were 2883 HER2+/ER+ and/or PR+ cases and 802 HER2+/ER-/PR- cases. The highest frequency of NCCN-preferred regimen use occurred in neoadjuvant chemotherapy for patients with Stage III HER2+/ER+ and/or PR+ disease, where 88% of 289 patients used an NCCN-preferred regimen. Metastatic HER2+ patients had a markedly lower rate of NCCN-preferred regimen use at 62% of 557 cases. Only 48% of 1096 patients with Stage I/II HER2+/ER+ and/or PR+ disease received NCCN-preferred regimens. Conclusions: Patients receiving neoadjuvant chemotherapy for HER2+ breast cancer receive NCCN-preferred regimens at significantly higher rates than patients receiving adjuvant chemotherapy or metastatic treatment. Less than half of patients receiving adjuvant chemotherapy are receiving NCCN-preferred regimens. Further study is needed to determine the reasons for low preferred regimen use and ways to optimize preferred regimen use in HER2+ breast cancer.

scholarly journals The Neutrophil–Lymphocyte Ratio has Little Impact on Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Surgery

2021 ◽  
Author(s):  
Katsuhisa Enomoto ◽  
Satsuki Fukumoto ◽  
Hironori Goto ◽  
Satoshi Mori ◽  
Yukiko Hara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Disease Free Survival ◽  
Breast Cancer Patients ◽  
Free Survival ◽  
Neutrophil Lymphocyte Ratio ◽  
Disease Free

Abstract Background: The impact of the neutrophil–lymphocyte ratio (NLR) on the survival outcomes of patients with early-stage breast cancer is controversial. Methods: We reviewed a series of 115 breast cancer patients who received neoadjuvant chemotherapy followed by surgical treatment. The NLR was calculated using a blood sample obtained before neoadjuvant chemotherapy. The relationships of disease-free survival with the NLR as well as other clinicopathological factors were assessed.Results: There was no significant association between the NLR and disease-free survival in these patients. On the other hand, negative estrogen receptor and progesterone receptor statuses, extended nodal involvement, and advanced TNM stage were significant predictors of shorter disease-free survival.Conclusions: The NLR has little impact on the survival of early-stage breast cancer patients treated with neoadjuvant chemotherapy followed by surgical treatment.

scholarly journals BREAST-CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN BREAST CANCER PATIENTS

2021 ◽  
Vol 20 (4) ◽  
pp. 116-121
Author(s):  
A. R. Bosieva ◽  
M. V. Ermoshchenkova ◽  
N. N. Volchenko ◽  
A. D. Zikiryahodjaev
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Disease Free Survival ◽  
Breast Conserving Surgery ◽  
Oncologic Outcomes ◽  
Cochrane Library ◽  
Breast Cancer Patients ◽  
Margin Width

The purpose of the study was to present the most recent data on the outcomes of breast-conserving surgery after neoadjuvant chemotherapy for breast cancer patients.Material and methods. We analyzed relevant publications available in the pubmed, cochrane library, e-library databases between 1990 and 2020, and 24 of them were used to write this review.Results. Neoadjuvant chemotherapy for breast cancer patients is currently a widespread treatment option. The main advantage of this type of treatment for patients with early stage breast cancer is the feasibility of performing breast-conserving surgery in cases of partial or complete clinical response and, therefore, the improvement of the quality of life of patients with equivalent rates of disease-free survival compared to radical mastectomies.Conclusion. Numerous studies have shown that breast-conserving surgery following neoadjuvant chemotherapy is the safe surgery with good oncologic outcomes and an alternative to radical mastectomies in breast cancer patients. However, further studies are required to determine the optimal safe resection margin width in patients with complete and partial responses to neoadjuvant chemotherapy.

Adjuvant treatment of early-stage HER2+ elderly breast cancer patients: A retrospective, multicenter French study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 636-636
Author(s):  
Philippe Barthelemy ◽  
Karine Bassot ◽  
Florence Joly ◽  
Isabelle Ray Coquard ◽  
Gilles Freyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Single Agent ◽  
Her2 Status ◽  
Routine Practice ◽  
Breast Cancer Patients ◽  
Her2 Breast Cancer

636 Background: Trastuzumab (T) is the standard of care for the adjuvant treatment of early stage, HER2+ breast cancer (BC). However, few data are available for elderly HER2+ breast cancer patients in this setting. In this current study, the patterns of care for elderly HER2+ early stage BC in 7 French cancer centres was evaluated. Methods: Medical records of all consecutive early stage HER2+ BC patients over 70 years old treated between 2006 and 2011 among participating centres were retrospectively reviewed. Specific factors such as age, comorbidities, tumor stage, grade, ER/PR and HER2 status, treatment characteristics, follow-up and cardiotoxicity data were analysed. Results: One hundred and two patients were identified, median age 75.4 (range 70-95). Elderly patients presented mostly (57%) large tumors (pT ≥2), and positive lymph node involvement (n=61). Trastuzumab-based adjuvant treatment was administered in 62% of patients (n=63). 54% of patients (n=55) received adjuvant chemotherapy whereas five patients received neoadjuvant chemotherapy. Chemotherapy without T was administered in 2 additional patients. Anthracyclines (A)-Taxanes (Ta) combination-based chemotherapy was given in 27% of patients (n=16), whereas 38% received a Ta-based chemotherapy (n=23), 35% (n=19) an A-based chemotherapy. Five patients received single-agent T. Treatment delays for T were required in 37% of patients (n=23) among whom 15 and 8 permanently or temporarily stopped T, respectively. The most frequent reason for interrupting or delaying therapy was cardiotoxicity (n=12) as well as patients refusal (n=7). A ≥ 10% decrease in LVEF was observed in 18/63 (29%) of patients, among whom T was stopped in 12. After a median 33 months follow-up, the median progression-free survival was not reached in patients receiving T-based therapy. The 2 and 3-year PFS rate were 94 and 89.5%, respectively. Conclusions: In routine practice only 62% of elderly early stage HER2+ BC patients are treated with a neoadjuvant or adjuvant T-based regimen. However, less than 50% of all patients completed their therapy. A-based chemotherapy was administered in around 60% of treated patients, and could explain cardiotoxicity in this setting.

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