The Who, What, Where, When and Sometimes, Why.

Neoadjuvant chemotherapy for invasive breast cancer

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Some women with invasive breast cancer may get chemotherapy before breast surgery (called neoadjuvant chemotherapy). 

Neoadjuvant chemotherapy may shrink tumors enough so a lumpectomy (breast-conserving surgery) becomes an option to a mastectomy.

Learn more about neoadjuvant chemotherapy.

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized controlled trials with at least 100 participants and meta-analyses.

Table note: These studies looked at different chemotherapy drug regimens, so results can’t be compared directly to one another. However, for each study, the neoadjuvant and adjuvant (after surgery) chemotherapy drug regimens are the same.

Study

Study Population
(number of participants)

Stage of Breast Cancer

Median Follow-up (years)

Chemotherapy Drug Regimen

Survival and Rate of Lumpectomy with Neoadjuvant Chemotherapy

Randomized controlled trials

NSABP B-18 [1]

1,493

T1-T3, N0-N1, M0

10

Doxorubicin, cyclophosphamide

Overall survival at 9 years:
69% with neoadjuvant therapy
vs.
70% with adjuvant therapy

Disease-free survival at 9 years:
55% with neoadjuvant therapy
vs.
53% with adjuvant therapy

Percentage of women with planned mastectomy who had lumpectomy instead:
16%

Gianni et al. [2]

902

T2-T3, N0-N1, M0

6

Doxorubicin, cyclophosphamide, methotrexate, 5-fluorouracil, paclitaxel

Disease-free survival at 6 years:
No difference between the 2 groups

Overall survival at 6 years:
No difference between the 2 groups

van der Hage et al. [3]

698

T1c, T2, T3, T4b, N0-N1, M0

5

Fluorouracil, epirubicin, cyclophosphamide

Overall survival at 4 years:
82% with neoadjuvant therapy
vs.
84% with adjuvant therapy

Progression-free survival at 4 years:
65% with neoadjuvant therapy
vs.
70% with adjuvant therapy

Percentage of women with planned mastectomy who had lumpectomy instead: 23%

Golshan et al. [4]

141
women with triple negative breast cancer

T1-T4a, N0-N2

Until surgery

Paclitaxel (with or without carboplatin and/or veliparib), doxorubicin and cyclophosphamide

Percentage of women with planned mastectomy who had the option of lumpectomy instead: 53%

Broët et al. [5]

390 premenopausal women

T2-T3, N0-N1, M0

9

Cyclophosphamide, doxorubicin, and 5-fluorouracil

Overall survival at 10 years:
65% with neoadjuvant therapy
vs.
60% with adjuvant therapy

Mauriac et al. [6]

272

T2 larger than 3 cm or

T3, N0-1, M0

10

Epirubicin, vincristine, methotrexate, mitomycin, thiotepa, vindesine

Overall survival at 10 years:
No difference between the 2 groups

Gazet et al. [7]

210

T1-T4, N0, N1-N2

5

Estrogen receptor-positive cancers: hormone therapy

Estrogen receptor-negative cancers: mitozantrone, mitomycin, methotrexate

Premenopausal cancers: goserelin

Postmenopausal cancers: formestane

Overall survival at 5 years:
79% with neoadjuvant therapy
vs.
87% with adjuvant therapy

Disease-free survival at 5 years:
No difference between the 2 groups

Lumpectomy rate:
60% had a less invasive surgery with neoadjuvant therapy

Meta-analyses

Chen et al. [8]

12 studies

Stage I-III

 

Various

Overall survival:
No difference between the 2 groups

Recurrence:
No difference between the 2 groups

Mieog et al. [9]

10 studies

Stage I-III

 

Various

Overall survival:
No difference between the 2 groups

Recurrence:
No difference between the 2 groups

Lumpectomy rate:
26% had a less invasive surgery with neoadjuvant therapy

References

  1. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. (30):96-102, 2001.
  2. Gianni L, Baselga J, Eiermann W, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol. 27(15):2474-81, 2009.
  3. van der Hage JA, van de Velde CJH, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 19(22):4224-37, 2001.
  4. Golshan M, Loibl S, Wong SM, et al. Breast conservation after neoadjuvant chemotherapy for triple-negative breast cancer: surgical results from the BrighTNess randomized clinical trial. JAMA Surg. 2020 Jan 8 [Epub ahead of print].
  5. Broët P, Scholl SM, de la Rochefordière A, et al. Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy: an updated analysis of a randomized trial. Breast Cancer Res Treat. 58(2):151-6, 1999.
  6. Mauriac L, MacGrogan G, Avril A, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol. 10(1):47-52, 1999.
  7. Gazet JC, Ford HT, Gray R, et al. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Ann Oncol. 12(5):685-91, 2001.
  8. Chen Y, Shi XE, Tian JH, Yang XJ, Wang YF, Yang KH. Survival benefit of neoadjuvant chemotherapy for resectable breast cancer: A meta-analysis. Medicine (Baltimore). 97(20):e10634, 2018.
  9. Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 94(10):1189-200, 2007.

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