Neoadjuvant chemotherapy versus surgery as the initial option for T3 breast cancer (>5 cm): real-world evidence from the Chinese Society of Clinical Oncology Breast Cancer database

Pathological complete response (pCR) achievement is undoubtedly the essential goal of neoadjuvant therapy for breast cancer, directly affecting survival endpoints. This retrospective study of 237 triple-negative breast cancer (TNBC) patients with a median follow-up of 36 months evaluated the role of adding platinum salts into standard neoadjuvant chemotherapy (NACT). After the initial four standard NACT cycles, early clinical response (ECR) was assessed and used to identify tumors and patients generally sensitive to NACT. BRCA1/2 mutation, smaller unifocal tumors, and Ki-67 ≥ 65% were independent predictors of ECR. The total pCR rate was 41%, the achievement of pCR was strongly associated with ECR (OR = 15.1, p < 0.001). According to multivariable analysis, the significant benefit of platinum NACT was observed in early responders ≥45 years, Ki-67 ≥ 65% and persisted lymph node involvement regardless of BRCA1/2 status. Early responders with pCR had a longer time to death (HR = 0.28, p < 0.001) and relapse (HR = 0.26, p < 0.001). The pCR was achieved in only 7% of non-responders. However, platinum salts favored non-responders’ survival outcomes without statistical significance. Toxicity was significantly often observed in patients with platinum NACT (p = 0.003) but not for grade 3/4 (p = 0.155). These results based on real-world evidence point to the usability of ECR in NACT management, especially focusing on the benefit of platinum salts.

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Neoadjuvant chemotherapy or surgery: which is the optimal initial option for T3 breast cancer (> 5 cm)——a real world research from Chinese society of clinical oncology breast cancer database

10.21203/rs.3.rs-18536/v1 ◽

2020 ◽

Author(s):

Haibo Wang ◽

Jianbin Li ◽

Meng Lv ◽

Yan Mao ◽

Gang Nie ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Cancer Patients ◽

Real World ◽

Maximum Diameter ◽

Chinese Society ◽

Breast Cancer Patients ◽

Her2 Positive ◽

Positive Lymph Nodes

Abstract Background: The objectives were to explore the real world treatment of T3 breast cancer (maximum diameter of tumor bigger than 5 centimeters). Materials and Methods: We selected T3 breast cases diagnosed from 2011 to 2017 in the CSCO BC database. These cases were categorized into two groups: non-NAC group and NAC group. Adjusted hazard ratios for known predictors of event free survival (EFS) using Kaplan-Meier and Cox proportional hazards regression. Results: The study included 868 patients: 49.0%(425/868) of patients chose NAC after diagnosis, 51.0%(443/868) chose surgery as their initial therapeutic strategy(non-NAC group). Compared with non-NAC group, patients in NAC group were correlated with clinical positive lymph nodes, hormonal receptor(HR) negative and human epidermal receptor growth factor 2(HER2) positive. For non-NAC group, only 87.1%(386/443) of patients were pathologic T3 after surgery, the overestimation of clinical examination of tumor lesion was 12.9%(57/443). In addition, there was no significance of EFS between the NAC group and non-NAC group(HR=0.82, 95%CI: 0.64-1.05). However, for T3 breast cancer patients with positive lymph nodes, HR negative and HER2 positive tumors, the NAC group had a better survival than the non-NAC group. Cox proportional analysis showed that lymph node negative, HER2 negative status and neoadjuvant chemotherapy were associated with a longer survival time. Conclusion: As the initial option for T3 breast cancer patients with positive lymph nodes, HR negative and HER2 positive tumors, neoadjuvant chemotherapy is the first therapy.

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Efficacy of First Line Regimens in Metastatic Breast Cancer Patients. Real World Evidence from Instituto Nacional de Cancerologia, Mexico City

The Breast ◽

10.1016/s0960-9776(17)30699-9 ◽

2017 ◽

Vol 36 ◽

pp. S50

Author(s):

Maria Tereza Nieto-Coronel ◽

Claudia Arce Salinas ◽

Ariana Tabares ◽

Jose Luis Aguilar-Ponce

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Cancer Patients ◽

Mexico City ◽

Real World ◽

Metastatic Breast ◽

Breast Cancer Patients ◽

First Line ◽

Real World Evidence

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Real-World Evidence: A Comparison of the Australian Herceptin Program and Clinical Trials of Trastuzumab for HER2-Positive Metastatic Breast Cancer

PharmacoEconomics ◽

10.1007/s40273-016-0411-2 ◽

2016 ◽

Vol 34 (10) ◽

pp. 1039-1050 ◽

Cited By ~ 7

Author(s):

Bonny Parkinson ◽

Rosalie Viney ◽

Marion Haas ◽

Stephen Goodall ◽

Preeyaporn Srasuebkul ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Metastatic Breast Cancer ◽

Real World ◽

Metastatic Breast ◽

Her2 Positive ◽

Real World Evidence

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Abstract PS7-82: A real-world evidence study of treatment patterns among patients with HER2-positive metastatic breast cancer

10.1158/1538-7445.sabcs20-ps7-82 ◽

2021 ◽

Author(s):

Jenna Collins ◽

Beth Nordstrom ◽

Jackie Kwong ◽

Brian Murphy ◽

Melissa Pavilack

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Real World ◽

Metastatic Breast ◽

Treatment Patterns ◽

Her2 Positive ◽

Real World Evidence

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The Use of Real-World Evidence for Oral Chemotherapies in Breast Cancer

Journal of the Advanced Practitioner in Oncology ◽

10.6004/jadpro.2021.12.2.12 ◽

2021 ◽

Vol 12 (2) ◽

Author(s):

Kirollos Hanna, PharmD, BCPS, BCOP ◽

Kelley Mayden, MSN, FNP, AOCNP

Keyword(s):

Breast Cancer ◽

Real World ◽

Drug Market ◽

Current Treatment ◽

Major Barrier ◽

Chemotherapy Drugs ◽

Oral Formulations ◽

Real World Evidence ◽

Almost All ◽

Oral Oncolytics

Almost all patients with breast cancer will eventually receive chemotherapy drugs, the majority of which are administered as IV infusions. Real-world evidence indicates that while current treatment paradigms vary considerably from guideline recommendations, there is an increasing trend towards a preference for oral oncolytics among patients with breast cancer. Recent data have shown that oral anticancer therapeutics represent 25% of the oncology drug market share and that there is a high demand for these agents. Therefore, oral formulations of chemotherapy agents such as paclitaxel are currently under development. Although oral oncolytics are associated with several advantages over conventional intravenous drugs, maintaining adherence to therapy is a major barrier in achieving improved outcomes with these agents. Advanced practitioners can facilitate improved adherence to oral oncolytics by integrating evidence into practice to support better education and communication strategies to address patient concerns, overcome key hurdles, and ultimately, empower patients.

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