Abstract P3-14-20: Neoadjuvant chemotherapy in young age breast cancer: Survival benefit over adjuvant chemotherapy in clinically T2 node positive patients
Authors: Kim MK , Moon H-G , Kim J , Lee JW , Kim J , Lee ES , Yoo T-K , Noh D-Y , Han W 
Published: August 2014

Background: The downstaging of the primary tumor and the increase in breast conservation rates seems to be the only clinical benefit of Neoadjuvant systemic therapy(NST) in breast cancer treatment, given that several studies failed to demonstrate an improvement of overall survival compared with postoperative adjuvant chemotherapy. In Europe, S6 trial showed better early outcome in survival in favour of the neoadjuvant chemotherapy group compared to adjuvant chemotherapy group in premenopausal patients without significantly modifying long-term event rates. The aim of this study was to assess a potential advantage in survival by neoadjuvant as compared to adjuvant chemotherapy in young age breast cancer patients.

Methods: Between January 2001 and December 2008, 1169 consecutive patients with breast cancer aged under 40 underwent adjuvant chemotherapy before or after surgery. Prospectively collected medical records for all patients were reviewed retrospectively. For the comparison of survival between neoadjuvant versus adjuvant chemotherapy group, cinically T2 and node positive patients were retrieved. Survival curves were derived from Kaplan-Meier estimates and compared by log-rank test.

Results: Of the 1169 patients, 203(17.3%) patients were treated with neoadjuvant chemotherapy, and they were grouped as ‘NST’ and ‘non-NST’ according to initial treatment. About 47% patients in each group were clinically T2 patients. (99(47.8%) in NST group, 453(46.9%) in non-NST group) Among them, clinically T2 and node positive patients were 188, 97 patients in NST group, 91 patients in non-NST group each. The median age was 35.11±3.9 years old and HER2 amplification was observed as 23.5%, and they were not different between two groups.(p = 0.146 and 0.941 each) Significant lower hormone receptor expression rate and higher Ki-67 level were observed in NST group(p = 0.03 and &lt;0.0001 each) Breast conservation surgery rate was also significantly different between two groups, more favorable results in NST group.(67% in NST group, 37.4% in non-NST group, p&lt;0.0001) During median follow-up period of 61 months (range 44 to 148 months), we observed a statistically significant difference (p = 0.011) in survival in favour of the NST group. This benefit of survival was presented consistently regardless of hormone receptor expression. A similar trend was seen when the time to distant disease recurrence was evaluated (p = 0.176). And this trend was more prominent in hormone receptor negative patients, but still not statistically significant. (p = 0.144) The mean total dose of chemotherapy administered was similar in both groups. Improved survival figures in the NST group could be the result of the early initiation of systemic treatment, but the trend in favour of decreased metastases was not statistically significant.

Conclusion: A potential advantage of primary over adjuvant chemotherapy in young age breast cancer patients’ survival might be proposed by this results.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-20.