Abstract P3-14-21: Neoadjuvant chemotherapy in gynecologic oncology practices in Germany: A real life documentation
Authors: Schilling J , Hindenburg H-J , Klare P , Wetzel A , Klare K , Orthner P 
Published: August 2014

Background: Several clinical studies have confirmed that neoadjuvant chemotherapy (NACT) is equally effective to adjuvant chemotherapy in patients with early breast cancer. The advantages of NACT include potentially improved rates of breast conserving surgery, the possibility of measuring early, in-vivo response to systemic treatment, and potentially improved outcomes for certain subgroups of high-risk breast cancer patients. The German Professional Association of Gynecologic Oncology in Practices (BNGO) is dedicated to quality-assured outpatient treatment of patients with gynecologic tumors. This includes adjuvant and neoadjuvant chemotherapy. In this analysis, we present our data on patients treated with neoadjuvant chemotherapy in BNGO practices. One of our important goals is the standardized documentation of diagnosis and treatment of our patients in order to control and assure the quality in our practices.

Methods: From January 2004 to May 2013, 18,319 breast cancer patients have been documented in the BNGO data base registry. 2,059 breast cancer patients (11%) received neoadjuvant chemotherapy. 90 BNGO practices participate in this registry on a regular basis. For documentation, the specialized ODM QuaSi®GYN online documentation system is used. The documentation assesses demographic data of individual patients and practices as well as data regarding diagnosis, treatment and outcome.

Results: Patient characteristics: Median age at diagnosis was 52 years (range 21-95 years). Most patients (30%) were 40-49 years old. 47% of patients had a T2 tumor and 81% had no distant metastases. 37% had no lymph node involvement (N0), 35% were classified as N1. 32% of patients had an ER-negative tumor, 37% were PR-negative. 57% had a negative HER-2 status, 25% were HER2-positive. Consequently, 20% of patients received trastuzumab in addition to their neoadjuvant chemotherapy. 82% of the patients were treated with a taxane-containing regimen and 84% received anthracyclines. Efficacy: Most patients (42%) achieved a partial remission (PR) after NACT, 27% had a complete remission (CR), 16% had stable disease (SD), 6% had progressive disease. 40% had breast conserving surgery of one or both breasts after NACT. 38% received other oncoplastic surgery, so a total breast conservation rate of 78% was achieved among the NACT-patients. Only 22% underwent mastecotomy of one or both breasts.

ResponseResponse% of patientsCR (Complete Remission)27%PR (Partial Remission)42%SD (Stable Disease)16%PD (Progressive Disease)6%NE (Not Evaluable)9%

52% of patients receiving neoadjuvant chemotherapy developed grade 3-4 leucopenia. The most frequent grade 3-4 non-hematologic toxicity was alopecia (9%).

Conclusions: Since 2004, 2,059 breast cancer patients in BNGO-practices received a neoadjuvant chemotherapy for early breast cancer. Most treatment schedules contained an anthracycline and /or a taxane. The objective response rate (PR and CR) was 69%. After NACT, breast conservation surgery was possible in nearly 80% of patients. This real life documentation with non- selected breast cancer patients compares favorably to results achieved in clinical trials with a selected patient population.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-21.