Neoadjuvant chemotherapy has been shown to result in similar survival outcomes to adjuvant chemotherapy in breast cancer patients with non-metastatic breast cancer1,2. The known benefits of neoadjuvant therapies are predominantly to downstage or facilitate surgery and to provide information on the biological response of the tumour to treatment. Response to neoadjuvant therapy, such as attaining a pathological complete response, has been shown to improve survival outcomes. However, more recently there are newer arguments emerging to support the use of neoadjuvant therapy such as the ability to facilitate early reconstruction.
The aim of this retrospective study was to evaluate patient selection, clinicopathological characteristics, surgical outcomes and survival over the past decade of treating patients with neoadjuvant chemotherapy at both The Austin and Northern Hospitals.
Neoadjuvant patients were identified from histopathology databases between 2004 and 2016 and were eligible for this analysis if they were non-metastatic at the time of commencing treatment. Clinicopathological characteristics, treatment intent, survival and surgical outcomes were recorded.
Eight-five patients with a mean age of 50 years at diagnosis. Nearly half (45%) of the breast cancers were T3 or T4 tumour size at baseline. Sixty-four percent of patients had oestrogen-receptor (ER) positive disease, 32% had HER2 positive disease and 17% had triple negative disease. Approximately 10% of treated patients were deemed inoperable at diagnosis. The vast majority (82%) of all patients underwent mastectomy. Ninety percent of patients received third-generation chemotherapy regimens and nearly all HER2 positive patients received adjuvant trastuzumab. The pathological complete response (pCR) rate was approximately 20%. Further results detailing surgical down-staging and uptake of immediate reconstructive surgery will be presented. One in four patients had a relapse event and 21% of patients had died with breast cancer recurrence.
This series describes our experience of using neoadjuvant chemotherapy in high-risk, non-metastatic patients. In this constantly evolving field particularly with the introduction of neoadjuvant targeted therapy in HER2-positive patients, there are emerging indications to consider neoadjuvant treatment that require further exploration.